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A core feature of GAD, excessive and uncontrollable worry, may be indicative of poor attentional control and difficulty disengaging attention from threatening or emotional information (e.g., Fox, 2004; Mathews, Fox, Yiend, & Calder, 2003; Yiend & Mathews 2001). The current study examined the performance of college students with and without self-reported GAD (N = 63) on measures of attentional control and a spatial cueing task designed to assess engagement-disengagement processes from emotionally valenced (aversive, pleasant) and neutral picture stimuli. Attentional control abilities were examined using the Stroop Color-Word Association Test (SCW Test) and Trail-Making Test (TMT). Separate analyses of variance (ANOVAs) demonstrated that GAD participants performed more poorly on the Stroop Color subtest and the TMT: Part B than non-GAD participants. Mixed ANOVAs of response times measured during the spatial cueing task revealed significant main effects for Cue Valence and Cue Validity, as well as several significant interactions of these variables with GAD status. The significant Cue Valence x Cue Validity x GAD status interaction indicated that GAD participants were slower to disengage their attention from aversive stimuli, relative to pleasant or neutral stimuli, than non-GAD participants who did not exhibit this bias. This interaction effect, however, did not remain significant upon covarying for depression. Together, these findings suggest that individuals with GAD evidence poorer attentional control and demonstrate difficulties disengaging from threatening stimuli compared to persons without the disorder. Impairment in these attentional processes may, therefore, contribute to the etiology and maintenance of GAD. / Psychology

Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and one that is particularly disruptive of social relationships. Socially anxious individuals often have trouble forming and maintaining intimate relationships, as evidenced by a high divorce rate and low relationship satisfaction within existing relationships. However, little is known about the specific reasons why relationships involving socially anxious individuals suffer. Initial research suggests that such relationships may be characterized by lower levels of emotional intimacy and difficulties managing and resolving conflict. The current study aimed to detect specific problems socially anxious individuals have communicating with their partners during conflict and support-seeking conversations. Male (n = 50) and female (n = 57) undergraduates ("actors") and their intimate partners ("partners") completed two videotaped conversations in our laboratory. One conversation featured a topic of conflict within the relationship, whereas the other focused on a personal problem experienced by the actor. Outcomes of interest included level of engagement and expressiveness of the actor, presence of positive (e.g., humor) and negative (e.g., withdrawal) communication behavior by the actor, feelings of satisfaction and closeness of both partners, and emotions experienced by both partners. We hypothesized that social anxiety would be associated with lower levels of engagement and expressiveness overall, but especially during conflict. Further, we hypothesized that those higher on social anxiety would demonstrate more negative communication behavior (such as expressing hostility toward their partners) during conflict. Results provided some evidence that socially anxious individuals were less engaged and expressive when speaking with their partners. However, there was no evidence that they used more negative communication behaviors. Our hypothesis that social anxiety would be associated with greater difficulty during conflict had minimal support; rather, conversations in which the actor elicited support appeared to be the most difficult for socially anxious individuals, particularly when emotional experience was considered. Clinical implications and ideas for further research are explored. / Psychology

Little to no research has evaluated factors that explain the manifestation and maintenance of bipolar disorder-anxiety disorder (BD-AD) comorbidity. The literature has shown that disruption of social and circadian rhythms is associated with mood episode onset. This association is especially pronounced among individuals who have a sensitive behavioral approach system (BAS). Inasmuch as anxiety sensitivity and trait anxiety have been associated both with BD and social rhythm disruption, it is worth examining whether anxiety sensitivity and trait anxiety confer risk for mood episode onset. The aims of this project were to: 1) evaluate trait anxiety and anxiety sensitivity as predictors of social rhythm disruption and BD-AD comorbidity, 2) examine social rhythm disruption (SRD) as a mediator of the association between trait anxiety and anxiety sensitivity and BD-AD comorbidity status, and 3) explore behavioral approach system sensitivity in these processes as contributing to the vulnerability to BD-AD comorbidity. A sample of 156 young adults participated in a multi-wave study in which they completed diagnostic interviews, symptom measures, and life event interviews which assessed the occurrence of positive and negative life events and the degree of SRD following these events every six months. Partial support for the hypotheses was found. Initial anxiety sensitivity, but not trait anxiety, positively predicted SRD for rewarding life events and follow-up bipolar symptoms. Additionally, SRD following positive life events predicted increases in depressive symptoms, but not hypomanic symptoms. SRD mediated the relationship between anxiety sensitivity and depressive symptoms. Furthermore, this relationship was stronger for healthy controls than for those with a bipolar disorder (BD) diagnosis or at-risk for developing BD. Moreover, individuals with a comorbid BD-AD diagnosis tended to have greater social rhythm disruption following negative life events than BD only or healthy individuals. Unexpectedly, individuals with comorbid BD-AD did not exhibit greater anxiety sensitivity or trait anxiety. Overall, the results suggest that anxiety sensitivity is a factor that may help to identify individuals who are vulnerable to bipolar symptoms. Furthermore, SRD is a mechanism that may partially explain this relationship. / Psychology

Ethnic minority youth use mental health services less frequently than Caucasian youth, despite similar rates of psychopathology. Research has documented ethnic differences in (1) parents' beliefs about the seriousness, prognosis, and etiology of child symptoms and (2) preferences for help-seeking, which may partially explain disparities in treatment utilization; however, few studies have examined underlying cultural factors that may account for ethnic differences or parent's beliefs and preferences with regard to youth anxiety. This study examined parents' beliefs about separation anxiety disorder (SAD) and preferences for help-seeking among 117 Indian-American (IA; n = 39), Puerto Rican (PR; n = 39), and European-American (EA; n = 39) mothers. After reading four vignettes describing SAD symptoms, parents rated the seriousness, prognosis, and etiology of symptoms and the likelihood of help-seeking. Parents also completed measures of acculturation, independent/interdependent self-construal, and strength of religious faith. RM-MANCOVA (controlling for SES) revealed that PR mothers were more likely than EA mothers to endorse medical etiology and were more likely than IA mothers to seek help from a physician. Hierarchical multiple regression revealed that acculturation and strength of religious faith predicted parents' etiological beliefs and preferences for help-seeking, after accounting for variance associated with SES and child gender. Results highlight the importance of examining cultural constructs that may contribute to ethnic differences. Implications for future research and clinical practice are discussed. / Psychology

Although several efficacious treatments exist for social anxiety disorder (SAD), less research has been devoted to identifying specific mechanisms involved in the etiology of SAD using high-risk, longitudinal designs. Given the high prevalence and personal and societal burden associated with a diagnosis of SAD, research is needed to elucidate causal factors at play in the development of SAD to inform innovative prevention programs for at-risk individuals. Theoretical models and empirical research suggest that biased attention toward threat-relevant information is an important factor in the maintenance of SAD. However, relatively little is known about the role of attention bias to threat in the development of SAD, and evidence is inconclusive with regard to whether attention biases lead to increases in anxiety over time. Also, only one study has examined attentional control as a potential factor moderating this relationship despite long-held assertions that "control over cognitive processes" may be an important individual difference factor determining the strength of the relationship between attention bias and development of excessive anxiety. Finally, a few studies have shown that attention bias to threat predicts stress reactivity, but these studies have only been conducted in unselected samples rather than with individuals at risk for developing SAD. Thus, the aims of this study were to examine the moderating effects of risk for SAD and attentional control on the relationships between attention bias to threat and (1) psychological and biological social stress reactivity and (2) development of SAD. The primary aim of the study was to examine the aforementioned relationships using attention bias to threat as assessed using the modified probe detection task (MPDT). In an exploratory analysis, the relationships were examined using an index of attention disengagement bias assessed with the Posner spatial cueing task (PSCT). Attentional control was represented by four indices, analyzed in separate regression analyses given their weak bivariate associations (i.e., Antisaccade task reaction time and accuracy rate, Attention Network Test executive control score, and total score on the Attentional Control Scale). First-year college students at low or high risk for developing SAD completed assessments of attention bias, attentional control, and anxiety during their first month of college. Approximately four months later, they completed a social stressor task and the same self-report measures of social anxiety. At the end of their first year in college, they completed the self-report measures of social anxiety once more, as well as a diagnostic interview for SAD. Correlational analyses indicated that attention bias to threat on the MPDT was associated with concurrent self-reported social anxiety but did not prospectively predict psychological or biological social stress reactivity, self-reported social anxiety, or SAD diagnostic status at the end of the first year in college. Hierarchical regression analyses supported the hypothesized double moderation for concurrent social anxiety, such that high levels of attentional control weakened the association between attention bias toward threat and social anxiety, only among the individuals at high risk for SAD. However, analyses did not support this relationship in predicting prospective outcomes, and several unexpected patterns emerged in which interactions between attention bias and attentional control were observed to predict prospective outcomes, but only among individuals at low risk for developing SAD. Likewise, exploratory analyses using the PSCT index of attention bias revealed unexpected interactions between risk group, attention bias, and attentional control. Considered together, results of the current study highlight the importance of considering individual differences in attention bias and attentional control in the maintenance and development of SAD. / Psychology

The degree to which patients and their therapists align over time on their perceptions of therapeutic processes and intermediary outcomes has generally been regarded as an important element of effective psychotherapy; however, few studies have examined empirically the influence of such dyadic convergences on ultimate treatment outcomes. This study examined (a) whether early treatment convergences in patient-therapist alliance and session progress ratings were associated with subsequent worry and distress reduction (and final posttreatment level) in psychotherapy for generalized anxiety disorder (GAD), and (b) whether treatment type and the initial (session 1) levels of perceived alliance and session progress moderated these associations. Data derived from a clinical trial in which patients with severe GAD were randomly assigned to receive either 15 sessions of cognitive-behavioral therapy (CBT; n = 43) or 4 sessions of motivational interviewing (MI) followed by 11 integrative CBT-MI sessions (n = 42). Patients and therapists rated the alliance and session progress after each session. Patients rated their worry and distress multiple times throughout treatment. Dyadic multilevel modeling revealed, as predicted, that alliance convergence over the first half of therapy was associated with greater subsequent worry (p = .03) and distress (p = .01) reduction. Additionally, the combination of low initial patient-rated alliance and early divergence was associated with the worst trajectory for the distress outcome (p = .04). Unexpectedly, session progress divergence had a near significant association with lower posttreatment worry (p = .05) and was significantly associated with more accelerated subsequent distress reduction (p = .03). Additionally, for patients who perceived their initial progress more positively, whether dyads converged or diverged in early session progress ratings affected the trajectories (though not the ultimate amount) of distress change (p = .02). These findings suggest that divergence of early patient-therapist alliance perspectives, especially when coupled with lower initial patient-rated alliance quality, may be an important marker for patient nonresponse and therapist responsiveness (e.g., use of alliance repair strategies). The findings on patient-therapist session progress convergence are less straightforward, though several possible implications are discussed.

The default mode network (DMN) is active in the absence of task demands and during self-referential thought. Considerable evidence suggests that the DMN is involved in normative aspects of social cognition, and as such, disruptions in the function of DMN would be expected in disorders characterized by alterations in social function. Consistent with this notion, work in autism spectrum disorder (ASD) and social anxiety disorder (SAD) has demonstrated altered activation of several core regions of the DMN relative to neurotypical controls. Despite emergent evidence for alterations within the same brain systems in SAD and ASD, as well as a behavioral continuum of social impairments, no study to date has examined what is unique and what is common to the brain systems within these disorders. Therefore, the primary aim of the current study is to precisely characterize the topology of neural connectivity within the DMN in SAD and ASD and neurotypical controls in order to test the following hypotheses through functional and structural connectivity analyses of the DMN. Our analyses demonstrate increased coavtivation of the dorsomedial prefrontal cortex in ASD and SAD compared to controls, as well as over and under connectivity in structural brain connectivity in ASD. These results may reflect general deficits in social function at rest, and disorder specific alterations in structural connectivity in ASD. / Master of Science

Studies suggest that sleep disturbance may be an important etiological factor in the development of comorbid anxiety and depressive disorders, whereby anxiety leads to sleep difficulties, which in turn increase the vulnerability for depression. The primary aim of this study was to determine whether the sequential comorbidity patterns observed at the disorder level (i.e., where anxiety disorders most often precede insomnia, and insomnia most often precedes depression) were also present in daily fluctuations of symptoms. The secondary aim was to explore possible moderators of any observed temporal associations. Participants were 15 patients with generalized anxiety disorder (GAD; mean age = 28.9 years, SD = 9.8) and 15 good sleeper controls (mean age = 27.1 years, SD = 8.3) who were comparable in female:male ratio (73% female vs. 67% female). For 14 days, participants wore an actigraph to objectively assess sleep quality (sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency) and completed daily symptom ratings multiple times each day using their smartphones to assess symptoms of anxiety, depressed mood, and subjective sleep quality. Study aims were assessed using multilevel modeling, with daily symptoms nested within individuals. Many of the analyses were lagged such that the time-varying predictor variable preceded the time-varying outcome variable temporally. Consistent with hypotheses, results demonstrated that anxious mood was predictive of later subjective and objective sleep disturbance in individuals with GAD, and this effect was strongest among individuals with higher levels of neuroticism, negative affect, and dysfunctional beliefs about sleep. Anxious mood was not associated with later subsequent sleep disturbance in healthy controls. In the GAD group, subjective and objective sleep disturbance predicted later depressed mood; this effect was moderated by temperament and dysfunctional beliefs about sleep. For the control group, the effect of subjective sleep disturbance on later depressed mood was moderated by neuroticism and the effect of objective sleep disturbance was moderated by dysfunctional beliefs about sleep, suggesting that sleep disturbance may increase vulnerability for depressed mood even in healthy individuals. These results suggest that explicitly targeting sleep disturbance during the treatment of GAD may attenuate the experience of depressive symptoms.