Difficulty concentrating in generalized anxiety disorder: An evaluation of incremental utility and relationship to worry

The Intrinsic Association of Posttraumatic Stress Symptoms Among Chinese Police Officers During COVID-19: Evidence From Network Perspective

BACKGROUND

The current study aimed to identify the core posttraumatic stress symptoms (PTSS) and to explore the longitudinal predictive relationships of these symptoms among Chinese police officers during COVID-19. Identifying the important symptoms of PTSS could help with informing future research to alleviate police officers' psychological problems.

METHODS

In this study, a two-wave on-line investigation (4 months interval; T1 and T2) was conducted with a sample of 891 Chinese police officers who completed the Chinese version of PTSD Checklist for DSM-5 (PCL-5). Cross-sectional network and cross-lagged panel network (CLPN) analyses were adopted.

RESULTS

The results showed that: (1) The most central nodes all belonged to the hyper-arousal and the negative cognition and emotion alteration clusters in both T1 and T2. (2) The strongest positive predictive paths were apparent from symptoms in hyper-arousal cluster to symptoms in negative cognition and emotion alteration cluster and intrusions cluster.

CONCLUSIONS

Hyperarousal is the core symptom cluster among police officers during COVID-19, and it positively predict negative cognition and emotion alteration symptoms and intrusions symptoms over time. Future research could focus more on these symptoms and examine their role in the onset and development of PTSS in police officers following traumatic events.

A temporal investigation of the relationship between difficulty concentrating and perseverative thought

Perseverative thought (also known as repetitive thought) is an established transdiagnostic mechanism of internalizing psychopathology characterized primarily by its repetitive, difficult to control quality. Subjective difficulty concentrating frequently coincides with perseverative thought and may function as both mechanism and clinical consequence of perseverative thought. Although cognitive theories suggest a bidirectional relationship between perseverative thought and difficulty concentrating, experimental and longitudinal investigations provide mixed evidence. The current study addresses this gap by testing a bidirectional relationship between momentary perseverative thought and difficulty concentrating using ecological momentary assessment (EMA) (8 surveys per day for 14 days) with 200 adult community participants (N = 155 with compliance ≥ 70 %) oversampled for moderate/severe perseverative thought. Multilevel modeling tested concurrent and time-lagged associations. Difficulty concentrating and perseverative thought were concurrently and prospectively related within-person: higher difficulty concentrating at T-1 predicted higher perseverative thought at T, and higher perseverative thought at T-1 predicted higher difficulty concentrating at T (β =.19 -.20, p < .001). Findings held when controlling for the outcome at T-1 (β =.02 - .06, p < .001). These findings demonstrate covariation between difficulty concentrating and perseverative thought within-person in daily life consistent with theoretical models that predict bidirectional relationships. Findings suggest that intervening on difficulty concentrating and/or perseverative thought may reduce the "vicious cycle" of perseverative thought episodes.

Brain Fog and Cognitive Dysfunction in Posttraumatic Stress Disorder: An Evidence-Based Review

The term "brain fog" has long been used both colloquially and in research literature in reference to various neurocognitive phenomenon that detract from cognitive efficiency. We define "brain fog" as the subjective experience of cognitive difficulties, in keeping with the most common colloquial and research use of the term. While a recent increase in use of this term has largely been in the context of the post-coronavirus-19 condition known as long COVID, "brain fog" has also been discussed in relation to several other conditions including mental health conditions such as post-traumatic stress disorder (PTSD). PTSD is associated with both subjective cognitive complaints and relative deficits on cognitive testing, but the phenomenology and mechanisms contributing to "brain fog" in this population are poorly understood. PTSD psychopathology across cognitive, affective and physiological symptom domains have been tied to "brain fog". Furthermore, dissociative symptoms common in PTSD also contribute to the experience of "brain fog". Comorbid physical and mental health conditions may also increase the risk of experiencing "brain fog" among individuals with PTSD. Considerations for the assessment of "brain fog" in PTSD as part of psychodiagnostic assessment are discussed. While standard psychological intervention for PTSD is associated with a reduction in subjective cognitive deficits, other cognitive interventions may be valuable when "brain fog" persists following PTSD remission or when "brain fog" interferes with treatment. Limitations of current research on "brain fog" in PTSD include a lack of consistent definition and operationalization of "brain fog" in the literature, as well as limited tools for measurement. Future research should address these limitations, as well as further evaluate the use of cognitive remediation as an intervention for "brain fog".

The Value of Non-Instrumental Information in Anxiety: Insights from a Resource-Rational Model of Planning

Anxiety is intimately related to the desire for information and, under some accounts, thought to arise from the intolerance of uncertainty. Here, we seek to test this hypothesis by studying the relationship between trait anxiety and the willingness to pay for non-instrumental information (i.e., information that reveals whether an event will happen but cannot be used to change the outcome). We model behavior with a resource-rational model of planning, according to which non-instrumental information is useful for planning ahead, but paying for this information only makes sense if the anticipated benefits of planning outweigh the cognitive and financial costs. We find a bidirectional effect of trait anxiety factors on information seeking behavior: those with high trait somatic anxiety exhibit a stronger preference for non-instrumental information, whereas those with high trait negative affect exhibit a weaker preference. By fitting the resource-rational model, we find that this divergent desire for information arises from the utility of obtaining information for future planning (increased in somatic anxiety, decreased in negative affect). Our findings lend support to the intolerance of uncertainty hypothesis in somatic anxiety and highlight the importance of studying anxiety as a multifactorial construct.

Longitudinal Associations Between Anxiety and Depressive Symptoms in Adolescence, Early Adulthood, and Old Age: Cross-Lagged Panel Network Analyses

Background: Depression and anxiety are among the most prevalent psychiatric disorders worldwide, affecting individuals of all ages. The co-occurrence of these disorders often exacerbates their negative health impacts, underscoring the necessity of understanding their comorbid mechanisms. Methods: This study employed cross-lagged panel networks (CLPNs) to explore the longitudinal associations between depression and anxiety symptoms across three age groups and to compare the respective symptom networks. CLPNs were constructed through cross-temporal associations between different symptoms, reflecting both the pattern of interaction and the significance of specific symptoms in comorbidity. The sample consisted of 1258 adolescents (aged 13-19 years, M = 15.98), 1118 college students (aged 17-24 years, M = 19.94), and 548 older adults (aged 60-101 years, M = 85.19) from China. Depression and anxiety symptoms were assessed using the subscales of the Depression, Anxiety, and Stress Scale Short Version (DASS-21) at two time points over a 6-month period during 2020-2021. Results: The findings revealed that the prevalence of depression and anxiety in adolescents, college students, and older adults was 25.9%/46.6%, 53.7%/61.5%, and 7.2%/22.5%, respectively. The network structure varied across age groups: adolescents and college students exhibiting a tight interconnection between depression and anxiety symptoms, while older adults showed stronger small-world network characteristics. A key finding across all age groups was the central role of irrational fear. In addition, somatic anxiety symptoms frequently emerged as outcomes of other psychological symptoms. Conclusion: Depression and anxiety are more pronounced in college students compared to adolescents and older adults. Comparisons of the overall network structure provide insights into the lifelong trajectories of depression and anxiety symptom networks. The centrality of irrational fears and somatization symptoms is emphasized. These results offer guidance for more targeted clinical interventions.

Examining network structure of impulsivity and depression in adolescents and young adults: A two-sample study

BACKGROUND

Depression ranks as one of the top five contributors to ill health in youth, the most formative period in life. Extensive research has highlighted the significant role of impulsivity in understanding depression. However, there has been limited exploration into how each dimension of impulsivity uniquely affect depressive symptoms, especially across crucial developmental stages like adolescence and young adulthood.

METHODS

This study investigates the unique relationships between impulsivity (assessed by the short UPPS-P scale) and depression (assessed by the Patient Health Questionnaire-9) via network analysis. We analysed data from a total of 2296 participants, comprising 858 adolescents aged 14-17 years and 1438 young adults aged 18-25 years, to estimate both a combined network and age-group specific networks. Key features of the networks, including their structure, global connectivity, and bridge nodes, were compared.

RESULTS

The results indicated that age differentially impacts individual depression symptoms, both directly and indirectly, via impulsivity dimensions. The comparison test revealed consistent network structures between the two age groups, with several robust pathways, such as lack of perseverance to concentration difficulties, sensation seeking to suicidal ideation, and negative urgency to feelings of worthlessness. Negative urgency and lack of perseverance were identified as bridge nodes across the two networks.

LIMITATIONS

The study employed a cross-sectional design, which limits the ability to estimate causal or temporal relationships.

CONCLUSIONS

The current findings highlight the significance of tailoring intervention strategies to individual symptom profiles and assessing negative urgency and lack of perseverance as potential early targets for depression among youth.

Academic self-efficacy and cognitive strategy use in college students with and without depression or anxiety

OBJECTIVE

This study examined whether college students with and without depression or anxiety differed in subjective cognitive concerns, academic self-efficacy, and cognitive strategy use.

PARTICIPANTS

Participants included 582 college students (M = 19.0 ± 1.0 years-old, 79.4% women, 81.9% White).

METHODS

Participants completed online self-report questionnaires on subjective cognitive functioning, academic self-efficacy, cognitive strategy use, and depression and anxiety symptoms, which were used to categorize participants as having anxiety or depression based on established clinical cutoffs.

RESULTS

Participants with anxiety or depression reported greater subjective cognitive concerns and lower academic self-efficacy compared to participants without anxiety or depression, but these groups differed only modestly in cognitive strategy use.

CONCLUSIONS

Despite greater cognitive concerns, participants with anxiety or depression reported only modestly greater cognitive strategy use. Future research should evaluate interventions to increase strategy use among college students with anxiety or depression, tailoring these interventions for modern students by incorporating telehealth approaches and smartphone use.

Efficacy of Internet-based rumination-focused cognitive behavioral therapy and mindfulness-based intervention with guided support in reducing risks of depression and anxiety: A randomized controlled trial

Rumination and worry are common risk factors of depression and anxiety. Internet-based transdiagnostic interventions targeting individuals with these specific risks may be an effective way to prevent depression and anxiety. This three-arm randomized controlled trial compared the efficacy of Internet-based rumination-focused cognitive behavioral therapy (RFCBT), mindfulness-based intervention (MBI), and psychoeducation (EDU) control among 256 at-risk individuals. Participants' levels of rumination, worry, depressive, and anxiety symptoms were assessed at post-intervention (6 weeks), 3-month, and 9-month follow-ups. Linear mixed model analysis results showed similar levels of improvement in all outcomes across the three conditions. Changes in rumination differed comparing RFCBT and MBI, where a significant reduction in rumination was noted at a 3-month follow-up among participants in RFCBT, and no significant long-term effect among participants in MBI was noted at a 9-month follow-up. All three conditions showed similar reductions in risks and symptoms, implying that the two active interventions were not superior to EDU control. The high attrition at follow-ups suggested a need to exercise caution when interpreting the findings. Future studies should tease apart placebo effect and identify ways to improve adherence.

A Dive into Delivery of Oral Hygiene Advice Based on the Personalized Oral Hygiene Advice Model

Oral health's impact on overall well-being highlights the importance of preventive measures through effective oral hygiene practices. Currently, there is growing recognition of the need for customized oral hygiene advice depending on the patient's unique needs and circumstances. This narrative review addresses the gap in understanding the significance of personalized guidance through the proposal of the Personalized Oral Hygiene Advice Model (POHAM) as a comprehensive guide for oral health professionals. This model was developed to adapt to evolving patient demographics and diverse challenges, promoting a patient-centric and effective oral health approach. The POHAM comprises a flow chart of strategies from establishing a good rapport with patients, conducting comprehensive assessment through history-taking, psychosocial and technology proficiency evaluation, tailored education modules, and customized oral care product recommendations until the reassessment. These strategies aim to enhance patient engagement and adherence, as well as act as a guide for oral health professionals to use in the clinical setting before and during the course of oral treatment. Nevertheless, continued research, education, and technological advancements are needed to realize the full potential of personalized oral hygiene strategies, ensuring a transformative and sustainable oral healthcare landscape.

Longitudinal Association Between Posttraumatic Stress Symptoms and Depression Symptoms Among Chinese Adolescents During COVID-19: Evidence from Network Perspective

Although there are an increasing number of studies that have explored the mental health consequences of COVID-19 focusing on revealing risk factors, the longitudinal research examining the potential mechanism of the co-occurrence of posttraumatic stress symptoms (PTSS) and depression symptoms among adolescents were scarce. The present study identified the important comorbidity symptoms and explored longitudinal relationship of PTSS and depression symptoms from the network perspective. A two-wave investigation (4 months interval; T1 and T2) was conducted with a sample of 1225 Chinese adolescents. Cross-sectional network and cross-lagged panel network (CLPN) analyses were adopted. Results showed that comorbidity symptoms consisted of both overlapping and non-overlapping symptoms, including "Future foreshortening" at T1 and T2 from PTSS, and "Hard to get started" at T1 and "Not sleep well" at T2 from depression symptoms. Strong longitudinal pathways appeared from all PTSS to depression symptoms, among which the pathway from "Difficulty concentrating" to "Hard to get started" was the strongest. These findings suggest that the possible comorbidity between PTSS and depression symptoms is caused by their independent and related structures, and their longitudinal association. Clinical intervention for these symptoms may alleviate adolescents' psychological problems in the aftermath of traumatic events.

A d factor? Understanding trait distractibility and its relationships with ADHD symptomatology and hyperfocus

People differ substantially in their vulnerability to distraction. Yet, many types of distractions exist, from external stimulation to internal thoughts. How should we characterize individual differences in their distractibility? Two samples of adult participants (total N = 1220) completed a large battery of questionnaires assessing different facets of real-world distractibility. Latent modeling revealed that these measures could be explained by three correlated-yet-distinct factors: external distraction, unwanted intrusive thoughts, and mind-wandering. Importantly, about 80% of the total variance in these three factors could be explained by a single higher-order factor (d) that could be construed in terms of a person's general distractibility, and this general distractibility model was replicated across the two samples. We then applied the general distractibility model to understand the nature of ADHD symptomatology and hyperfocus (an intense state of long-lasting and highly focused attention). d was substantially associated with self-reported ADHD symptoms. Interestingly, d was also positively associated with hyperfocus, suggesting that hyperfocus may, to some degree, reflect attention problems. These results also show marked consistencies across the two samples. Overall, the study provides an important step toward a comprehensive understanding of individual differences in distractibility and related constructs.

Abbreviated version of Penn State Worry Questionnaire for Chinese adolescents: Age, gender and longitudinal invariance

The abbreviated version of Penn State Worry Questionnaire (PSWQ-A) has been widely used to assess worry. However, its measurement invariance has been not yet warranted. With a cross-sectional and a longitudinal sample of Chinese adolescents (N1 = 1,329, N2 = 408), this study examined age, gender, and longitudinal invariance of PSWQ-A. Results supported strict invariance, including configural, metric, scalar, and error level, across gender and age in the cross-sectional sample; strict longitudinal measurement invariance was also supported in the longitudinal sample. This study suggests the application of the PSWQ-A in measuring adolescent worry and a basis for comparisons of different populations and occasions for worry.

A Pilot Randomized Controlled Trial of Goal Management Training in Canadian Military Members, Veterans, and Public Safety Personnel Experiencing Post-Traumatic Stress Symptoms

Post-traumatic stress disorder (PTSD) is a severe psychiatric illness that disproportionately affects military personnel, veterans, and public safety personnel (PSP). Evidence demonstrates that PTSD is significantly associated with difficulties with emotion regulation (ER) and difficulties with cognitive functioning, including difficulties with attention, working memory, and executive functioning. A wide body of evidence suggests a dynamic interplay among cognitive dysfunction, difficulties with ER, and symptoms of PTSD, where numerous studies have identified overlapping patterns of alterations in activation among neuroanatomical regions and neural circuitry. Little work has examined interventions that may target these symptoms collectively. The primary objective of this pilot randomized controlled trial (RCT) with a parallel experimental design was to assess the effectiveness of goal management training (GMT), a cognitive remediation intervention, in reducing difficulties with cognitive functioning, and to determine its effects on PTSD symptoms and symptoms associated with PTSD, including difficulties with ER, dissociation, and functioning among military personnel, veterans, and PSP. Forty-two military personnel, veterans, and PSP between the ages of 18 and 70 with symptoms of PTSD were recruited across Ontario, Canada between October 2017 and August 2019. Participants were randomized to either the waitlist (WL) (n = 18) or the GMT (n = 22) condition. Participants in both conditions received self-report measures and a comprehensive neuropsychological assessment at baseline, post-intervention, and 3-month follow-up. Following their completion of the 3-month follow-up, participants in the WL condition were given the opportunity to participate in GMT. Assessors and participants were blind to intervention allocation during the initial assessment. A series of 2 (time) × 2 (group) ANOVAs were conducted to assess the differences between the WL and GMT conditions from pre- to post-intervention for the self-report and neuropsychological measures. The results demonstrated significant improvements in measures of executive functioning (e.g., verbal fluency, planning, impulsivity, cognitive shifting, and discrimination of targets) and trending improvements in short-term declarative memory for participants in the GMT condition. Participants in the GMT condition also demonstrated significant improvements from pre- to post-testing in measures of subjective cognition, functioning, PTSD symptom severity, difficulties with ER, dissociative symptom severity, and depression and anxiety symptoms. No adverse effects were reported as a result of participating in GMT. The results of this pilot RCT show promise that GMT may be a useful intervention to improve symptoms of cognitive dysfunction, symptoms of PTSD, and symptoms associated with PTSD within military personnel, veterans, and PSP. Future work is needed to address the small sample size and the durability of these findings.

Attentional networks in co-occurring generalized anxiety disorder and major depression disorder: Towards a staging approach to the executive control deficits

INTRODUCTION

Major Depression Disorder (MDD) and Generalized Anxiety Disorder (GAD) often co-occur, but the neurocognitive mechanisms of this co-occurrence remain unknown. Prominent views have pointed to attentional processes as potent mechanisms at play in MDD and GAD, respectively. Yet uncertainty remains regarding the very nature of attentional impairments in patients with co-occurring MDD and GAD.

METHODS

Inspired by contemporary models of attentional networks, we compared the three main attentional networks, namely the orienting, alerting, and executive networks of the Attention Network Task's model, in four groups of patients with, respectively, co-occurring DSM-5 MDD and GAD (n = 30), DSM-5 MDD only (n = 30), DSM-5 GAD only (n = 30), or free from any DSM-5 diagnosis (n = 30). To capture the multivariate nature of our data, we examined between-group differences in the attentional networks through a multivariate analysis of variance.

RESULTS

Patients with co-occurring MDD and GAD exhibited more severe impairments in the executive control network than those with only one of the disorders. Although patients with MDD or GAD solely did not differ in terms of attentional impairments, both groups showed significantly more impairments in the executive control network than those free from any DSM-5 diagnosis (all Bonferonni-corrected post-hoc ps < 0.05).

CONCLUSIONS

Our findings align with a longstanding staging approach to comorbidity whereby, via synergistic effects, co-occurring disorders produce more damages than the sum of each disorder. Here, for the first time, we extended this approach to the executive network of attention in the context of the co-occurrence between MDD and GAD.

Integrating trauma, self-disturbances, cognitive biases, and personality into a model for the risk of psychosis: a longitudinal study in a non-clinical sample

The hypothesis of the psychosis continuum enables to study the mechanisms of psychosis risk not only in clinical samples but in non-clinical as well. The aim of this longitudinal study was to investigate self-disturbances (SD), a risk factor that has attracted substantial interest over the last two decades, in combination with trauma, cognitive biases and personality, and to test whether SD are associated with subclinical positive symptoms (PS) over a 12-month follow-up period. Our study was conducted in a non-clinical sample of 139 Polish young adults (81 females, age M = 25.32, SD = 4.51) who were selected for frequent experience of subclinical PS. Participants completed self-report questionnaires for the evaluation of SD (IPASE), trauma (CECA.Q), cognitive biases (DACOBS) and personality (TCI), and were interviewed for subclinical PS (CAARMS). SD and subclinical PS were re-assessed 12 months after baseline measurement. The hypothesized model for psychosis risk was tested using path analysis. The change in SD and subclinical PS over the 12-month period was investigated with non-parametric equivalent of dependent sample t-tests. The models with self-transcendence (ST) and harm avoidance (HA) as personality variables were found to be well-fitted and explained 34% of the variance in subclinical PS at follow-up. Moreover, we found a significant reduction of SD and subclinical PS after 12 months. Our study suggests that combining trauma, cognitive biases, SD and personality traits such as ST and HA into one model can enhance our understanding of appearance as well as maintenance of subclinical PS.

Irritability in Mood Disorders: Neurobiological Underpinnings and Implications for Pharmacological Intervention

Feeling irritable is a common experience, both in health and disease. In the context of psychiatric illnesses, it is a transdiagnostic phenomenon that features across all ages, and often causes significant distress and impairment. In mood disorders, irritability is near ubiquitous and plays a central role in diagnosis and yet, despite its prevalence, it remains poorly understood. A neurobiological model of irritability posits that, in children and adolescents, it is consequent upon deficits in reward and threat processing, involving regions such as the amygdala and frontal cortices. In comparison, in adults with mood disorders, the few studies that have been conducted implicate the amygdala, orbitofrontal cortices, and hypothalamus; however, the patterns of activity in these areas are at variance with the findings in youth. These age-related differences seem to extend to the neurochemistry of irritability, with links between increased monoamine transmission and irritability evident in adults, but aberrant levels of, and responses to, dopamine in youth. Presently, there are no specific treatments that have significant efficacy in reducing irritability in mood disorders. However, treatments that hold some potential and warrant further exploration include agents that act on serotonergic and dopaminergic systems, especially as irritability may serve as a prognostic indicator for overall clinical responsiveness to specific medications. Therefore, for understanding and treatment of irritability to advance meaningfully, it is imperative that an accurate definition and means of measuring irritability are developed. To achieve this, it is necessary that the subjective experience of irritability, both in health and illness, is better understood. These insights will inform an accurate, comprehensive, and valid interrogation of the qualities of irritability in health and illness, and allow not only a clinical appreciation of the phenomenon, but also a deeper understanding of its important role within the development and manifestation of mood disorders.

Executive function as a mechanism linking socioeconomic status to internalizing and externalizing psychopathology in children and adolescents

INTRODUCTION

The association between low socioeconomic status (SES) in childhood and increased risk for psychopathology is well established, but the mechanisms explaining this relationship are poorly understood. Here, we investigate the potential role of difficulties in executive functioning (EF) as a mechanism linking childhood and adolescent SES with externalizing and internalizing psychopathology.

METHODS

We examined whether difficulties with EF mediated the association between SES and externalizing and internalizing psychopathology in two cross-sectional samples of children and adolescents (Study 1: N = 94, ages 6-18, 51.1% male; Study 2: N = 259, ages 8-16, 54.1% male) from diverse SES backgrounds in the United States. EF was measured through behavioral tasks and parent-reported behavioral regulation (BR).

RESULTS

In both samples, children and adolescents from lower SES families were more likely to experience both externalizing and internalizing psychopathology than youth from more advantaged backgrounds and exhibited greater EF difficulties - they had lower performance on a task measuring inhibitory control and lower parent-rated BR. Reduced inhibitory control and BR, in turn, were associated with higher externalizing and internalizing psychopathology. In Study 1, difficulties with BR mediated the association of low-SES with both externalizing and internalizing psychopathology. In Study 2, low inhibitory control mediated the association between low-SES and externalizing psychopathology. These findings largely persisted after adjusting for exposure to violence, a form of adversity that is common in children from low-SES backgrounds.

CONCLUSIONS

These findings suggest that reduced EF may be an underlying mechanism through which low-SES confers risk for psychopathology in children and adolescents.

Attention Problems and Restlessness as Transdiagnostic Markers of Severity and Treatment Response in Youth with Internalizing Problems

Transdiagnostic models of psychopathology suggest that disorders may share common features that could influence their severity. Attention problems and psychomotor restlessness are included in the diagnostic criteria for several disorders, including disorders on the internalizing spectrum, but their transdiagnostic significance has received little attention. The present study identifies patterns of attention problems and restlessness among youth with internalizing problems, in order to understand their clinical significance in terms of internalizing symptom severity and response to cognitive behavioral therapy (CBT). Participants were 142 adolescents age 11-18 clinically referred for mood and/or anxiety problems. Latent class analysis was used to identify patterns of self-reported attention problems and psychomotor restlessness, and classes were compared on internalizing, depression, and anxiety severity. Differences in treatment response were examined in a subset of youth (n = 82; age 14-18) who participated in group CBT. Youth in the Attention Problems class (42% of sample) and youth in the Restless class (15% of sample) endorsed significantly more internalizing, depression, and anxiety problems than youth with Low Symptoms of attention problems or psychomotor restlessness (43% of sample). Youth in the Restless class responded significantly better to CBT than youth in the Low Symptoms of attention problems or psychomotor restlessness class in terms of decrease in overall internalizing problems. Attention problems and psychomotor restlessness appear to be important transdiagnostic markers of severity across the internalizing spectrum; however, they do not limit the effectiveness of CBT and, in the case of psychomotor restlessness, may forecast a good treatment response.

Mobile app-based chatbot to deliver cognitive behavioral therapy and psychoeducation for adults with attention deficit: A development and feasibility/usability study

BACKGROUND

Attention deficit is a growing problem in adults, and early diagnosis and treatment are needed. Previous studies have shown that cognitive behavioral therapy (CBT) is effective in improving attention deficit symptoms. However, many patients are not receiving adequate treatment due to time, space, and cost constraints. Recently, in other mental illnesses, mobile-based chatbots delivering CBT and psychoeducation have been used for symptom mitigation and treatment.

OBJECTIVE

This study aimed to investigate the feasibility and usability of a short-term intervention, specifically a mobile-based interactive chatbot application, in alleviating attention deficit symptoms.

METHODS

This was a randomized, non-blind parallel-group pilot study conducted from September 2019 to March 2020. Forty-six individuals with attention deficit aged 19-60 were randomly allocated to the chatbot (n = 23) and information-only control groups (n = 23) for 4 weeks. The former group was instructed to use the chatbot application "Todaki," while the latter group was provided with a book on managing attention deficit symptoms. Participants were administered questionnaires to assess their symptoms of attention deficit, depression, and anxiety and evaluated at baseline and 4 weeks after the intervention. The post-intervention survey assessed the chatbot's usability, acceptability, and side effects.

RESULTS

The average age of the participants was 25.1 years (standard deviation [SD] 7.5 years), and 56.5 % (26/46) participants were female. Intention-to-treat analysis (chatbot, n = 23; control, n = 23) revealed a significant reduction of attention deficit symptoms only in the chatbot group, which is represented by group-by-time interaction in Conner's Adult ADHD Rating Scale subscales of Diagnostic and Statistical Manual-IV Attention-Deficit/Hyperactivity Disorder (ADHD) Hyperactive-Impulsive symptoms (F = 4.39; p = .04) and ADHD symptoms total (F = 6.74, p = .01). Further, the results of the paired t-test were significant only in the chatbot group. The average number of times the chatbots were used in 4 weeks was 20.32 (SD 12.89). The total average usage time was 1 h 15 min (SD 1 h 20 min). The degree of improvement in the ADHD symptoms total score was correlated with the number of times the psychoeducation program was used. According to the participants, the empathic/friendly character and unnatural flow of conversation were the best and worst features of the chatbot, respectively.

CONCLUSIONS

This study identified the feasibility and usability of using the mobile-based chatbot to improve attention deficit and its associated psychiatric symptoms. Using this novel intervention to conduct CBT would provide a useful digital therapeutic tool that allows easy accessibility and self-guided management for people with attention deficit, which should be verified through the large scale randomized controlled trial.

Worry impairs the problem-solving process: Results from an experimental study

INTRODUCTION

Many individuals believe that worry helps solve real-life problems. Some researchers also purport that nonpathological worry can aid problem solving. However, this is in contrast to evidence that worry impairs cognitive functioning.

OBJECTIVE

This was the first study to empirically test the effects of a laboratory-based worry induction on problem-solving abilities.

PROCEDURE

Both high (n = 96) and low (n = 89) trait worriers described a current problem in their lives. They were then randomly assigned to contemplate their problem in a worrisome (n = 60) or objective (n = 63) manner or to engage in a diaphragmatic breathing task (n = 62). All participants subsequently generated solutions and then selected their most effective solution. Next, they rated their confidence in the solution's effectiveness, their likelihood to implement the solution, and their current anxiety/worry. Experimenters uninformed of condition also rated solution effectiveness.

RESULTS

The worry induction led to lower reported confidence in solutions for high trait worry participants, and lower experimenter-rated effectiveness of solutions for all participants, relative to objective thinking. Further, state worry predicted less reported intention to implement solutions, while controlling for trait worry. Finally, worrying about the problem led to more elevated worry and anxiety after solving the problem compared to the other two conditions.

CONCLUSIONS

Overall, the worry induction impaired problem solving on multiple levels, and this was true for both high and low trait worriers.

Worry alters speed-accuracy tradeoffs but does not impair sustained attention

Worry has been experimentally linked to a range of cognitive consequences, including impairments in working memory, inhibition, and cognitive control. However, findings are mixed, and the effects of worry on other phenomenologically-relevant constructs, such as sustained attention, have received less attention. Potential confounds such as speed-accuracy tradeoffs have also received little attention, as have psychometric and related design considerations, and potential moderators beyond trait worry. The present study investigated the effects of experimentally-induced worry versus a neutral control condition on speed-accuracy tradeoff-corrected performance on a validated measure of sustained attention (88 participants; within-subjects). Moderation by trait worry and trait mindfulness was probed in confirmatory and exploratory analyses, respectively. Worry led to faster and less accurate responding relative to the neutral comparison condition. There was no main effect of condition or trait worry on sustained attention after accounting for speed-accuracy tradeoffs. In exploratory analyses, higher trait mindfulness was robustly related to better post-worry performance, including after controlling for trait worry, general distress, and post-neutral performance, and correction for multiple comparisons. Follow-up analyses exploring dissociable mindfulness facets found a robust relationship between present-moment attention and post-worry performance. Future research should experimentally manipulate mindfulness facets to probe causality and inform treatment development.

Influence of comorbid anxiety symptoms on cognitive deficits in patients with major depressive disorder

BACKGROUND

Major depressive disorder (MDD) patients with comorbid anxiety symptoms showed obvious cognitive deficits. However, it remains unclear whether comorbid anxiety symptoms will make a specific contribution to cognitive deficits in MDD.

METHODS

Executive function, processing speed, attention and memory were assessed in 162 MDD patients, and 142 healthy controls (HCs) by a comprehensive neuropsychological battery. 14-item Hamilton Anxiety Rating Scale (HAM-A) was used for anxiety symptoms and MDD patients with HAM-A total score >14 were classified into MDD with comorbid anxiety (MDDA) group. A multivariate analysis of covariance and regression models was conducted to evaluate the effects of anxiety symptoms on cognitive deficits.

RESULTS

There were no significantly differences in all 4 cognitive domains between MDD alone and MDDA patients (all p < 0.05). In MDDA subgroup, HAM-A total score contributed to executive function and memory (both p < 0.05), while HAM-A psychic symptoms contributed to all 4 domains (all p < 0.05). Moreover, after controlling for the severity of depression, either anxiety symptoms shown as HAMA total score or psychic anxiety symptoms only contributed significantly to the executive function performance.

LIMITATIONS

The cross-sectional design made it hard to acquire a cognitive performance trajectory accompanied by the fluctuations in anxiety symptoms.

CONCLUSION

Our findings suggest that there is no significant difference in cognitive performance between MDD alone and MDDA patients. However, comorbid anxiety, especially psychic anxiety may contribute to extensive cognitive deficits in MDDA patients. Notably, anxiety symptoms only independently triggered executive dysfunction when eliminating effect of the severity of depression.

"Cold" Cognitive Control and Attentional Symptoms in Anxiety: Perceptions Versus Performance

Clinically significant anxiety is associated with an array of attentional symptoms (e.g., difficulty concentrating; unwanted thought) that are subjectively experienced as severe. However, neuropsychological findings are mixed with respect to the presence of cognitive deficits that can account for these symptoms. Contextualizing predictions from established clinical theories (e.g., Attentional Control Theory) within contemporary, neurobiologically derived models of cognitive control (Dual Mechanisms of Control Theory), the present study investigated the relationship between "cold" proactive and reactive cognitive control, task effort, and subjective attentional symptoms (difficulty concentrating; unwanted thought) in a mixed clinical sample of individuals with generalized anxiety disorder (GAD) and/or obsessive-compulsive disorder (OCD) and a comparison sample of healthy controls. Clinical status moderated the relationship between attentional symptoms (attentional focusing and trait worry) and proactive cognitive control response time. Clinical status also moderated the relationship between trait worry and task effort. Higher trait worry was associated with slower proactive control and lower effort in healthy participants, but faster proactive control in clinical participants. Self-reported attentional focusing showed differential validity vis-à-vis proactive control response time in clinical versus healthy participants. Post-hoc conditional effects analysis suggested more accurate self-appraisals in healthy controls, but was not significant after correction for multiple comparisons. Preliminary evidence suggested that differences in task effort in anxious versus healthy adults may relate to subjective attentional symptoms in GAD and OCD.