Research indicates that without healthy and close relationships, well-being and functioning suffer. Despite this knowledge, quality of relationships has not been emphasized in the mental health literature, especially as related to social anxiety disorder (SAD) where social support needs may be higher. The aim of this study was to examine how those with SAD compared to those with another anxiety disorder (generalized anxiety disorder; GAD), a mood disorder (major depressive disorder; MDD) and those with no recent history of disorder, on measures of quality of relationships with family, friends and partners, as well as on intimacy and role functioning. Data were drawn from the National Comorbidity Survey Replication (NCS-R; Kessler et al., 2004), a large, U.S. nationally-representative epidemiological data set. Logistic regressions were used to examine the quality of relationships for those with SAD as compared to GAD, MDD and no disorder. The associations among relationship quality and high versus low severity of SAD were also examined. It was found that those with SAD were less likely to report high family and friend support than were those with no disorder, but more likely to report high marital support than those with GAD or MDD. Those with SAD were more likely to report high family stress than those with no disorder, but no more likely to report relationship stress than were the other clinical groups. With respect to severity of SAD, those with high SAD severity were more likely to report high friendship stress than those with low SAD severity. In examining role impairment, those with SAD were less likely to report social impairment than those with GAD or MDD, and less likely to report close relationship impairment than those with MDD. Those with high SAD severity reported higher impairment across social and close relationship functioning compared to those with low severity. This study redresses many of the limitations in the current literature, and the results inform future research efforts on treatment practices and prevention.

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Ways to reduce the impact of worry in generalized anxiety disorder (GAD) have received little experimental research attention. Previous research has found that those with GAD are vulnerable to negative emotionality immediately following periods of worry; emotion regulation strategies could be useful to mitigate reactivity following worry. One promising strategy is mindfulness, defined as sustained attention toward the present moment with an attitude of curiosity and acceptance. Experimental research has found that mindfulness reduces negative affect and improves emotion regulation. This strategy is likely more effective than thought suppression, a common strategy used in GAD. This online study recruited 300 individuals with analogue GAD who completed several self-report measures of worry severity, emotion dysregulation, mindfulness, and experiential avoidance and underwent experimental inductions of worry (versus no-worry control) and regulation strategy (mindfulness versus thought suppression versus no-strategy control) before watching a sad film clip and reporting state affect and emotion dysregulation. Contrary to hypotheses, the mindfulness manipulation did not have a buffering effect on the relation between worry and negative affect or emotion dysregulation. The only predicted significant finding indicated that the mindfulness manipulation had a main effect on negative affect, with visual trends indicating that this effect was driven by those who did not worry. An exploratory analysis indicated that a mindfulness manipulation increased positive affect following worry, however. Clinical implications and future directions are discussed.

Background: Emigration of health-care workers is a problem within global health systems which affects many countries, including Peru. Several factors have caused health-care workers to emigrate, including burnout syndrome (BS). This study aims to identify the association between BS and its dimensions with the intention of physicians and nurses to emigrate from Peru in 2014. Methods: A cross-sectional study, based on a secondary analysis of the National Survey of Health Users (ENSUSALUD - 2014) was conducted. Sampling was probabilistic, considering the 24 departments of Peru. We include the questionnaire for physicians and nurses, accounting for 5062 workers. BS was measured by the Maslach Burnout Inventory-Human Services Survey. Adjusted odds ratio (OR) was calculated using multiple logistic regression. Results: Of the study population, 44.1% were physicians, 37.7% males, and 23.1% were working in Lima. It was found that 2.8% [95% confidence interval (CI): 2.19–3.45] of health-care workers had BS. The overall prevalence of intention to emigrate among health-care workers was 7.4% (95% CI: 6.36–8.40). Association was found between BS and intention to emigrate in Peruvian health-care workers (OR = 2.15; 95% CI: 1.05–4.40). Emotional exhaustion was the BS dimension most associated with intention to emigrate (OR = 1.80; 95% CI: 1.16–2.78). Conclusion: Physicians and nurses from Peru who suffered from BS were more likely to have intention to emigrate. Policies should be established to reduce BS as a strategy to control “brain drain” from health-care workers of Peru. / Revisión por pares

A single case study using a narrative approach to therapy was undertaken to examine the process and outcomes of therapy with a case of a 12 year old boy who presented with what could be described as an "anxiety disorder". The results were contrasted with the possible process and outcomes should a cognitive-behavioural approach have been used. This aspect of the Study was necessarily a speculative endeavour. Specific behaviours of the client and significant others were measured pre, post and followup. Positive changes occurred in the following behaviours: absence from school, reports of victimization, positive and negative self statements and statements by significant others.

This thesis investigates the experience of agoraphobia among one hundred research participants by focusing on how social interactions contribute to the onset, the unmanaged symptoms stage, and the managed symptoms stage of this anxiety disorder. The study investigates how social interactions such as family upbringings, familial stressful events, one-off and clusters of traumatic events and accumulated stressful events can contribute to the onset of agoraphobia. It examines how research participants' social interactions during their primary and secondary school years, youth, everyday life, travel, marriage/intimate relationships, parenting, post secondary education and employment were affected during the unmanaged symptom stage of agoraphobia. Participants' experiences of the public perception of agoraphobia, stigma and discrimination, coming out experiences and family and friends' reaction to agoraphobia are also explored. The third stage of the study examines social interactions that hinder or promote the management of agoraphobia. The former are found to include hiding panic attacks, making excuses, using flawed personal coping mechanisms and alcohol. Social interactions that were found to assist in the management of agoraphobia include labelling and learning about the mental illness from others, using companions in public places and situations, and seeking help from knowledgeable health professionals. Other forms of interaction that helped with management included participants' usage of Internet chat-rooms and websites as well as the discovery of faith and spiritual experience. Finally the study investigates research participants' changed social interactions following their emergence from the shadow of agoraphobia.

This study aimed to examine how variants in diagnostic labels might alter stigma toward Generalized Anxiety Disorder (GAD) sufferers and secondly, to evaluate an existing scale (GASS) designed to measure that stigma. Data was collected from Swedish university students (N=447) where the impact of labeling upon stigma was measured by manipulating the presence and content of a label. Psychometric properties of the GASS were investigated and compared to the properties reported by the developers of the scale. Due to conflicting findings, further examination appears necessary. Results revealed that the presence of a general label (diagnosis cluster) reduced stigma opposed to the absence of a label. Conclusion was drawn that GAD sufferers should specify their problems with a general label to reduce stigma held toward them. / Syftet med denna studie var att undersöka hur skillnader av framställd diagnosetikett påverkar stigma mot personer med Generaliserat Ångestsyndrom, samt att utvärdera ett befintligt mätinstrument (GASS) vilken mäter detta stigma. Data samlades in från svenska universitetsstudenter (N=447) och stigmats påverkan av etiketter mättes genom manipulation av närvarande, samt typ, av etikett. Mätinstrumentet utvärderades genom jämförelse med tidigare resultat vilka presenterats av mätinstrumentets utvecklare. Med hänvisning till motstridiga resultat behövs ytterligare utvärdering av mätinstrumentet. Resultat visade att en generell etikett (diagnosens kluster) minskade stigma i jämförelse med frånvaro av en etikett. Slutsats drogs att de som lider av GAD, bör specificera sina problem på generell nivå för att minska stigma mot sig.

Generalized Anxiety Disorder (GAD) is one of the most common and impairing childhood anxiety disorders, impacting over 10% of children with an average age of onset at 8.5 years. GAD in childhood increases the risk for developing additional anxiety and depressive disorders, academic and social difficulties, and, if left untreated, continuity into adulthood. While treatments incorporating mindfulness techniques have been shown to be efficacious among adults, relatively few studies have examined the efficacy of these techniques in the treatment of children. Mindfulness skills may be able to target maladaptive cognitive patterns by teaching children more flexible ways of thinking and viewing the world and providing children additional coping skills that may positively impact their overall functioning long-term. The aim of the present study was to develop and provide preliminary evaluation of a mindfulness-based intervention for GAD in school-aged children. Four children aged 9 to 12 with a principal diagnosis of GAD completed an open trial pilot phase of a 6-session individual format mindfulness intervention. Each session emphasized mindful awareness of breath, body, and thoughts, and involved child and parent participation. An additional twelve children were randomized to either an immediate treatment (n = 6) or a waitlist (i.e., delayed treatment; n = 6) condition during the course of a randomized waitlist-controlled clinical trial. Measures were administered at pre-waitlist (if applicable), post-waitlist/pre-treatment, post-treatment, and eight weeks following treatment to assess overall program satisfaction and changes in symptoms and diagnosis. Overall, treatment dropout was low, and families reported high satisfaction with treatment. Relative to waitlist, children in the immediate treatment group evidenced significant difference in mean change scores on Clinical Global Improvement Severity score and Child Behavioral Checklist Internalizing and Anxiety Problems scales. Effect size statistics indicated very large effect sizes between the waitlist and immediate treatment groups for change in GAD Clinical Severity Rating, child self-report of worries, and mindfulness ability, despite non-statistical significance. Overall, the intervention demonstrated feasibility, acceptability, and preliminary evidence of potential efficacy even in this small pilot study. Effect size estimates suggest a larger randomized clinical trial is warranted to fully evaluate treatment efficacy.

Purpose: There is accumulating evidence that treatment preference may significantly impact treatment compliance and satisfaction in individuals with psychological disorders. Very few studies have examined treatment preferences in clients with social anxiety disorder (SAD). Moreover, little is known if treatment preference for a conventional therapy such as cognitive behavioural therapy versus mindfulness-based interventions, influence outcomes. The primary objective of the current study was to determine whether treatment expectancy and preferences for a mindfulness intervention adapted for SAD (MBI-SAD), cognitive behavior group therapy (CBGT), or no preference, would influence treatment compliance and treatment satisfaction. Method: The sample included 97 participants who met the DSM-5 criteria for SAD. After selecting a treatment preference, participants were randomly assigned to a treatment group. Analyses of variance, chi-square, and logistic regressions were conducted to determine if being matched to one’s preferred treatment influenced outcomes, and if those with no preference differed from those who indicated a preference. Hierarchical multiple regression was used to determine if participants’ perceptions of credibility and expectations and match to treatment influenced compliance and satisfaction. Results: There was some support that treatment preference and match to treatment influenced compliance and satisfaction, however the majority of the analyses revealed no impact of treatment preferences. CBGT met expectations more often than did MBI-SAD when participants were matched to their preferred treatment. When participants were matched to their preferred treatment or had no preference, they were more compliant with homework than those who were not matched. Those with no preference had lower attendance than both the matched and not matched groups. Perceived credibility and expectancy were higher for those who were matched to their preferred group, however this did not have an impact on compliance and satisfaction. The remainder of the analyses did not find a relationship between treatment preference or match to treatment on compliance or satisfaction.