Generalised Anxiety Disorder: relationships with Eysenck's, Gray's and Newman's theories

Resting state connectivity patterns associated with trait anxiety in adolescence

Anxiety symptoms occur more frequently during adolescence and early adulthood, increasing the risk of future anxiety disorders. Neuroscientific research on anxiety has primarily focused on adulthood, employing mostly univariate approaches, discounting large-scale alterations of the brain. Indeed adolescents with trait anxiety may display similar abnormalities shown by adults in brain regions ascribed to the default mode network, associated with self-referential thinking and rumination-related processes. The present study aims to explore resting-state connectivity patterns associated with trait anxiety in a large sample of young individuals. We analyzed the rs-fMRI images of 1263 adolescents (mean age 20.55 years) and their scores on anxiety trait. A significant association between trait anxiety and resting-state functional connectivity in two networks was found, with some regions overlapping with the default mode network, such as the cingulate gyrus, the middle temporal gyri and the precuneus. Of note, the higher the trait anxiety, the lower the connectivity within both networks, suggesting abnormal self-referential processing, awareness, and emotion regulation abilities in adolescents with high anxiety trait. These findings provided a better understanding of the association between trait anxiety and brain rs-functional connectivity, and may pave the way for the development of potential biomarkers in adolescents with anxiety.

Differential Associations of Intrapersonal and Interpersonal Emotion Regulation with Generalized Anxiety and Social Withdrawal Among Children

Anxiety and social withdrawal are common internalizing problems among children linked to poor emotion regulation (ER). We investigated how specific components of ER (emotion awareness, emotion regulation strategy) are associated with generalized anxiety and social withdrawal in the two ER domains (intrapersonal and interpersonal). Study participants were 398 fourth- and fifth-grade students (49% girls) and 22 teachers from a Midwestern state in the United States. Study constructs were measured with student self-report, peer nominations, and teacher reports. We found anxiety was linked to poorer intrapersonal emotion awareness and greater use of adaptive and maladaptive intrapersonal regulation strategies. Social withdrawal was associated with poorer interpersonal emotion awareness and lower use of supportive and unsupportive interpersonal regulation strategies. Social withdrawal was also negatively associated with intrapersonal, adaptive strategy. The findings highlight the relevance of intrapersonal and interpersonal domains of ER in helping anxious and socially withdrawn children regarding their unique emotion regulation difficulties.

Trait anxiety mediates the association between hippocampal-insula functional connectivity and anxiety symptom severity in adults with and without generalized anxiety disorder

BACKGROUND

Trait anxiety is a vulnerability factor for the development of generalized anxiety disorder (GAD). The hippocampus has been implicated in trait anxiety in normal and GAD populations. However, the exact neural mechanism of hippocampal functional connectivity (FC) and its association with clinical symptoms and trait anxiety in GAD patients remains unknown.

METHODS

We recruited 68 participants (37 drug-naïve non-comorbidity GAD patients and 31 matched healthy controls (HC)), assessed their trait and state anxiety, scanned them with structural and resting-state functional magnetic resonance imaging (fMRI), and compared their hippocampal FC and volumes. We explored the relationships between hippocampal FC, clinical symptoms, and trait anxiety using partial correlation analyses; we also investigated the mediating effects of trait anxiety on the association between hippocampal FC and GAD symptom severity.

RESULTS

The GAD group showed increased right hippocampal FC with left insula, which was positively correlated with the Self-Rating Anxiety Scale (SAS), State Anxiety Inventory (SAI), and Trait Anxiety Inventory (TAI). Trait anxiety mediated the relationship between hippocampal FC and anxiety levels. We found no significant difference in hippocampal volumes between GAD and HC.

LIMITATIONS

The sample size was moderate. The exclusion of comorbidity may reduce the generalizability of our results in normal clinical settings.

CONCLUSIONS

The GAD patients showed no structural change but had functional alterations in the hippocampus. More importantly, future psychotherapy for this disorder should consider that trait anxiety might play a crucial role in the altered hippocampal FC in GAD.

The influence of environmental crisis perception and trait anxiety on the level of eco-worry and climate anxiety

Eco-anxiety, which refers to the anxiety experienced in response to worsening environmental conditions, is a growing global phenomenon. Climate change anxiety, due to the escalating impact of ongoing climate change, stands out as the most commonly recognized form of eco-anxiety. Nevertheless, numerous uncertainties persist regarding the relationship of this eco-anxiety response to pro-environmental behaviors, as well as its connection with trait anxiety and the perception of the environmental crisis. In this study, we conducted an analysis with a sample size of 431 participants to elucidate the respective implications of these factors, delving into the different facets of the eco-anxiety response: worry and anxiety-related impairments. We measured eco-worry using a brief 5-item scale and assessed climate anxiety-related impairments using the Climate Change Anxiety Scale (CCAS). Our findings reveal that eco-worry acts as a mediator between the perception of the environmental crisis and the manifestation of climate anxiety-related impairments. Furthermore, eco-worry plays a constructive role in relation to the commitment to pro-environmental behaviors, with no additional contribution from the climate anxiety reaction involving impairments. In summary, our findings underscore the existence of distinct constructs within the anxiety response to climate change and environmental issues, each with different contributing factors.

The Mediating Role of Emotion Regulation Strategies in the Relationship Between Big Five Personality Traits and Anxiety and Depression Among Chinese Firefighters

Identification of protective factors to prevent firefighters' anxiety and depression is meaningful. We explored whether emotion-regulation strategies mediate the relationship between personality traits and anxiety and depression among Chinese firefighters. Approximately, 716 Chinese firefighters were recruited and completed the Emotion Regulation Questionnaire (ERQ), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Big Five Inventory−2 (BFI-2) Scale. Results (N = 622) indicated that only negative emotionality traits could predict anxiety symptoms. Meanwhile, the multilevel mediation effect analyses showed that conscientiousness through cognitive reappraisal could reduce anxiety and depression symptoms in Chinese firefighters. Our findings clarify Chinese firefighters' underlying emotion-regulation process between personality traits and anxiety and depression. Implications, limitations, and future directions are discussed.

Illness Severity Moderated Association Between Trait Anxiety and Amygdala-Based Functional Connectivity in Generalized Anxiety Disorder

Trait anxiety is considered a vulnerability factor for the development of generalized anxiety disorder (GAD). The amygdala is related to both trait anxiety and GAD. Thus, we investigated amygdala-based functional connectivity (FC) in drug-naive non-comorbid GAD patients and explored its associations with personality, symptoms, and illness severity. FC analyses using the bilateral amygdala as seeds were performed with resting-state functional MRI data from 38 GAD patients and 20 matched healthy controls (HCs). Clinical characteristics were correlated with FC Z-scores from regions showing significant group differences. Furthermore, moderation analyses were used to explore the conditional effect of illness severity measured by the Clinical Global Impression-Severity (CGI-S) scale on the relationship between FC and trait anxiety. Relative to HCs, GAD patients showed hypoconnectivity between the amygdala and the rostral anterior cingulate cortex (rACC), inferior frontal gyrus (IFG), parahippocampal gyrus, and cerebellum and hyperconnectivity between the amygdala and the superior temporal gyrus (STG), insula, and postcentral gyrus. In GAD patients, amygdala-rACC connectivity was negatively associated with symptom severity and trait anxiety, and amygdala-IFG connectivity was positively associated with symptom severity. Moreover, CGI-S scores moderated the negative correlation between trait anxiety and amygdala-rACC FC. We demonstrate that there is extensive amygdala-based network dysfunction in patients with GAD. More importantly, amygdala-rACC connectivity plays a key role in the neural pathology of trait anxiety. Finally, the more severe the illness, the stronger the negative association between trait anxiety and amygdala-rACC FC. Our results emphasize the importance of personalized intervention in GAD.

Personality Traits and Postnatal Depression: The Mediated Role of Postnatal Anxiety and Moderated Role of Type of Birth

This study investigated how personality traits are related to postnatal depression 2 weeks after giving birth and whether these relations are mediated by postnatal anxiety, measured after 3–4 days after giving birth and moderated by the type of birth. New mothers (N = 672, Mage = 29.33) completed scales assessing their personality traits, postnatal anxiety, and postnatal depression 3 or 4 days after giving birth (T1). They also reported postnatal depression 2 weeks after giving birth (T2). Path analysis indicated that postnatal anxiety explained the link between personality traits (i.e., neuroticism) and postnatal depression 2 weeks after childbirth. The type of birth moderated the relation among, personality traits, postnatal anxiety and depression. Neuroticism and consciousness, in the natural birth’s group, and neuroticism and agreeableness, in the cesarean birth’s group, were associated with postnatal depression. Further, anxiety explained the relation between neuroticism and postnatal depression in both natural and cesarean birth groups. In addition, postnatal anxiety mediated the relation between extraversion and postnatal depression in the cesarean birth group. Our findings highlight that postnatal anxiety is a potential mechanism explaining how personality traits (i.e., neuroticism, extraversion) are related to postnatal depression, and that these relations may depend on the type of childbirth.

Social anxiety disorder and childhood trauma in the context of anxiety (behavioural inhibition), impulsivity (behavioural activation) and quality of life

Background

Social anxiety disorder (SAD) is one of the most prevalent psychiatric disorders in South Africa. Previous studies have linked childhood trauma with the development of SAD. The behavioural inhibition system (BIS) and the behavioural activation system (BAS), two dimensions of personality related to anxiety and impulsivity, respectively, are said to influence the development of psychopathology, including SAD. Both SAD and childhood trauma have an impact on quality of life. This study investigated the relationship between BIS, BAS and quality of life in patients with SAD with and without exposure to childhood trauma, compared to healthy controls.

Method

Data were collected for 102 adults. A total of 76 participants met SAD criteria, of which 51 were exposed to childhood trauma and 25 were not. The remaining 26 participants were demographically matched healthy controls. Measures of anxiety, impulsivity and quality of life were obtained by administering Carver and White’s BIS/BAS scales and the Quality of Life Enjoyment and Satisfaction Questionnaire – Self Report.

Results

A positive correlation was found between the severity of SAD symptoms and the amount of childhood trauma exposure. No significant differences in impulsivity were found across the three groups. Healthy controls reported significantly lower anxiety and a better quality of life than both groups with SAD, while no differences were found between patients with SAD and childhood trauma and those without childhood trauma.

Conclusion

More childhood trauma exposure appears to be associated with greater SAD severity. The lack of differences in BIS, BAS and quality of life in patients with SAD with or without childhood trauma requires further investigation.

Trust: An Integrative Review from a Person–Situation Perspective

Trust is a key aspect of various social interactions. Correspondingly, trust has been heavily studied across different scientific disciplines. However, an integration of the diverse research and literature is still missing. Addressing this issue, we review several hundred articles on interpersonal trust among strangers and integrate them into a coherent framework, explaining trust behavior among unfamiliar agents based on an interaction between situational features and distinct personality characteristics. Understanding trust as a decision under risk, we distill 3 core components of trust behavior from the extant literature: attitudes toward risky prospects (i.e., risk aversion and loss aversion), trustworthiness expectations, and betrayal sensitivity. Each of these refers to a distinct set of causal determinants, including personality characteristics (anxiety/fear, trustworthiness, and forgiveness) which can be localized in the space defined by models of basic personality structure (e.g., the Five-Factor Model and the HEXACO model of personality). In sum, the review contributes to the understanding of trust behavior by linking and integrating the findings from various fields of trust research. Additionally, it provides fruitful directions and implications for future research.

A Twin Study of Lifetime Generalized Anxiety Disorder (GAD) in Older Adults: Genetic and Environmental Influences Shared by Neuroticism and GAD

The nature of Generalized Anxiety Disorder (GAD) and worry across the lifespan remains incompletely understood. We investigated genetic and environmental influences on GAD and the proportion of genetic and environmental variation in GAD that is shared with neuroticism in older adult twins. Participants included 1618 monozygotic and 2291 same-sexed dizygotic twin pairs from the Swedish Twin Registry aged 55 to 74. Participants provided personality information in 1973 and also participated in a telephone screening between 1998 and 2002 that included an assessment for lifetime GAD. Univariate biometric models indicated that both GAD and neuroticism were moderately heritable (.27 and .47, respectively), while the balance of variation reflected environmental factors unique to the individual. Bivariate analyses indicated that approximately one third of the genetic influences on GAD were in common with genetic influences on neuroticism, while individual specific environmental influences were virtually unshared between GAD and neuroticism. Analyses of sex effects suggested that men and women differed in the frequency of lifetime GAD and level of neuroticism; however, no sex differences for genetic and environmental influences for either trait were identified.

Effects of Personality on Psychiatric and Somatic Symptoms in Pregnant Women

The authors examined the effects of personality and pregnancy worries on pregnant women’s mental and physical health with 154 women in the first half of their gestational period. Self-report questionnaires were used to collect information about control variables, sociodemographic (age, educational level, and work), and pregnancy variables (previous miscarriages, weeks of gestation, and planned pregnancy). Personality was measured using the NEO Five-Factor Inventory, pregnancy worries by the Cambridge Worry Scale, psychiatric clinical symptomatology using the Symptom Checklist-90-R (SCL-90-R), and physical symptomatology with the Nausea and Vomiting in Pregnancy Instrument. Significant relations were observed between pregnancy worries, the traits of agreeableness and neuroticism, and all the SCL-90-R dimensions. The analyses revealed a direct effect of neuroticism and agreeableness on pregnancy worries. Pregnancy worries mediated the effects of both neuroticism and agreeableness on interpersonal sensitivity, hostility, and paranoid ideation. Worries were found not to have mediating effects between personality and somatic symptomatology. These results suggest that neuroticism exerts a negative effect on the psychological health of pregnant women, whereas agreeableness has a positive effect (both as a direct effect and as an indirect effect mediated by pregnancy worries). These findings have important practical implications regarding the planning of health care programs for pregnant women: Specifically, health professionals must take personality into account as a potential determinant of pregnant women’s health, not only for the prevention of risks (in the case of neuroticism) but also for promoting health (in the case of agreeableness).

Polymorphisms in the GAD2 gene-region are associated with susceptibility for unipolar depression and with a risk factor for anxiety disorders

Glutamate decarboxylase (GAD) is the rate limiting enzyme for conversion of glutamic acid to gamma-aminobutyric acid (GABA). The GAD 65 kDa isoform is encoded by the gene GAD2 and is mainly expressed in synaptic terminals. It serves as an apoenzyme, which shows enhanced availability in situations of stress, responding to short-term demands for GABA. We analyzed 18 single nucleotide polymorphisms (SNPs) in the GAD2-gene region for associations with psychiatric diagnosis and behavioral inhibition (BI) derived from the personality traits neuroticism and extraversion as defined by the Eysenck Personality Questionaire (EPQ). A total of 268 patients with anxiety disorder (AD), 541 with unipolar depression (MD), and 541 healthy controls were included. We observe associations for five tag-SNPs with BI in the AD- and control samples as well as two additional case-control associations in the MD-sample. The associated SNPs lie within a 16KB linkage disequilibrium-block, including putative 5' GAD2-promoter-elements as well as the 3' end of the gene MYO3A. Using open access mRNA-expression data, we could show that BI-associated SNPs appear to be associated with differences in MYO3A- but not GAD2 lymphoblastoid-mRNA expression levels. These results support earlier studies that suggest associations of polymorphisms within the GAD2 locus with anxiety and affective disorders. However, data from expression studies imply that these polymorphisms could tag functional effects on the neighboring gene MYO3A, which is also expressed in the brain, including the cingulate cortex and the amygdala.

Self-reported symptoms of depressed mood, trait anxiety and aggressive behavior in post-pubertal adolescents: Associations with diurnal cortisol profiles

The association between self-reported symptoms and diurnal cortisol profiles was studied in post-puberty adolescents (29 boys and 29 girls, M(age)=15.06 years). The adolescents completed the Children's Depression Inventory, State Trait Anxiety Inventory, and an Aggressive behavior scale. The diurnal cortisol profile was derived from three saliva samples, collected at awakening, noon and evening on a week-end day. Univariate repeated measurement regressions revealed that depressed mood and trait anxiety were strongly and aggressive behavior was weakly related to the diurnal cortisol profile: greater emotional distress was associated with flatter diurnal cortisol profiles. Multivariate analysis, however, revealed that only trait anxiety made an independent contribution. Further analyses suggested that trait anxiety was related to elevated evening cortisol rather than to decreased awakening cortisol and that from a trait anxiety score of 38 onwards, high anxious adolescents show clearly higher evening cortisol than low anxious adolescents. These data suggest that anxiety disorder co-morbidity might explain some of the differences in HPA-axis function among depressed patients.

Personality traits and anxiety symptoms: The multilevel trait predictor model

Investigation of relations between personality traits and mental disorders can inform key issues in psychopathology research. However, it has been hindered by extensive correlations among the traits. Building on studies of affect-psychopathology relations (e.g., the tripartite model), an organizational framework is proposed to solve this problem with respect to anxiety pathology. To test the resulting model, associations between four traits (negative emotionality, positive emotionality, anxiety sensitivity, and negative evaluation sensitivity) and four anxiety symptoms (chronic worry, obsessive-compulsive symptoms, panic, and social anxiety) were examined in an undergraduate sample (N=907). Confirmatory factor analyses supported operationalizations of the constructs in this study. Examination of the trait-symptom links using hierarchical multiple regression analyses supported most of the predicted relations. Specifically, negative emotionality emerged as a general predictor that was significantly related to all four symptom dimensions. In contrast, anxiety sensitivity was specific to panic and worry, whereas negative evaluation sensitivity was specific to social anxiety and worry. Finally, positive emotionality was uniquely related to social anxiety. The model accounted for a substantial amount of variance in the symptoms and almost all of the covariation among them.

Personality traits as risk factors of depression and anxiety among Japanese students

The aim of this study is to examine the effects of personality (temperament and character) on specific depression and specific anxiety. A total of 541 Japanese undergraduates were investigated by using the Temperament and Character Inventory (TCI) and the Hospital Anxiety and Depression (HAD) scale. Hierarchical multiple regression analyses demonstrated that specific depression was predicted by lower Reward-Dependence, Persistence, Self-Directedness, Cooperativeness, and Self-Transcendence; specific anxiety was predicted by higher Novelty-Seeking, Harm-Avoidance, Persistence, and Self-Transcendence, and lower Self-Directedness. Immaturity of Self-Directedness is a risk factor for negative affectivity. Immaturity of all character dimensions is a risk factor for specific depression. The relationship between Harm-Avoidance and depression in previous studies may be linked partly to somatic symptoms that were deliberately eliminated in the HAD scale.

Neuroticism as a common feature of the depressive and anxiety disorders: A test of the revised integrative hierarchical model in a national sample

The revised integrative hierarchical model of depression and anxiety (S. Mineka, D. Watson, & L. A. Clark, 1998) proposes that high levels of neuroticism are shared between the depressive and anxiety disorders. This perspective was evaluated with data from the National Comorbidity Survey (N = 5,847), a population-based community sample. Analyses were based on both a broadband (i.e., diagnostic class) and a narrowband (i.e., specific disorder) approach. Results supported the model insofar as high neuroticism was shared across the depressive and anxiety disorders and was particularly elevated in people with comorbid depression and anxiety. Results are discussed in terms of their implications for understanding the association between personality and the depressive and anxiety disorders in a community sample and for the revised integrative hierarchical perspective.

Personality and risk of cognitive impairment 25 years later

The authors examined the relationship between personality and cognitive impairment in 4,039 members of the Swedish Twin Registry. Neuroticism and extraversion scores were collected in 1973 at midlife, and cognitive impairment was assessed in the same group 25 years later. Data were analyzed with case-control and co-twin control designs. Greater neuroticism was associated with higher risk of cognitive impairment in the results from case-control, but not from co-twin, analyses. Compared with both extraversion and introversion, moderate extraversion was associated with lower risk of cognitive impairment in both case-control and co-twin designs, as was the combination of high neuroticism and low extraversion. Findings are discussed in the context of theories related to personality, psychological distress, arousal, and cognitive function.