Change-talk (CT), or self-arguments for change, has been associated with favorable patient outcomes, while counter change-talk (CCT), or self-arguments against change, has been associated with poorer outcomes. Most studies on change language have focused on the prediction of distal posttreatment outcomes, while the prediction of more proximal outcomes has remained largely untested. Addressing this gap, we examined early treatment CT and CCT as predictors of worry change trajectories, “hazard” of clinically significant response, and time to response (i.e., outcome efficiency) in CBT and CBT integrated with MI (MI-CBT) for generalized anxiety disorder (GAD). We also explored whether treatment type moderated these associations. Data derived from a randomized controlled trial comparing CBT (n = 43) and MI-CBT (n = 42) for GAD. Independent observers reliably coded CT/CCT during session 1. Patients rated their worry after every session. Multilevel modeling revealed that, across both treatments, more CT associated with lower midtreatment worry level (p = .03), whereas more CCT associated with a slower rate of worry reduction at midtreatment (p = .04). However, treatment moderated the associations between CT and both midtreatment worry level (p = .004) and rate of change (p = .03). In CBT, patients with higher vs. lower CT had less worry and a faster rate of worry reduction; in MI-CBT, CT was unrelated to midtreatment worry level and the rate of worry change. Treatment did not moderate the CCT-worry relations. Survival analyses revealed that, across both treatments, more CT associated with a greater hazard of response (p = .004) and approached a faster time to response (p = .05), and more CCT associated with a lower hazard of response (p = .002) and approached a slower time to response (p = .06). Patient motivational language predicts proximal outcomes, and may be useful in differential treatment selection.

Aim: A randomized clinical trial demonstrated that responsively adding motivational interviewing (MI) to cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) outperformed CBT alone on long-term worry reduction (Westra et al., 2016). Consistent with MI’s additive aim, this effect was mediated by less patient midtreatment resistance in the integrative treatment (Constantino et al., 2019). Insofar as GAD is marked by interpersonal styles of excessive nonassertiveness and over accommodation, I tested here whether MI-CBT also outperformed CBT, across acute treatment and long-term follow up, on reducing these characteristic interpersonal problems. Moreover, as patient resistance is an interpersonal event for which person-centered MI should, according to theory, be more helpful than directive CBT, I tested if resistance also mediated the expected effect of treatment on the long-term interpersonal outcomes. Method: Eighty-five patients with severe GAD were randomly assigned to 15 sessions of MI-CBT or CBT. Patients completed a measure of interpersonal problems repeatedly through treatment and 12 months of follow up. Independent observers rated patient resistance at a midtreatment session. Results: As expected, structural equation models revealed comparable reductions in nonassertiveness and over accommodation across acute MI-CBT and CBT. Also as predicted, MI-CBT vs. CBT promoted significantly greater reduction in over accommodation problems over long-term follow up; however, this differential effect was only marginally significant for nonassertiveness problems. Finally, as predicted, the treatment effect on the level of both interpersonal problems at 12-month follow up was mediated by less midtreatment resistance in MI-CBT vs. CBT. Discussion: Results support that the benefit of adding MI to CBT for GAD extends to long-term interpersonal change, and they implicate resistance management as a candidate mechanism of this additive effect.

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Bakgrund: Psykisk ohälsa är idag ett vanligt hälsoproblem hos unga svenska kvinnor. Ett växande intresse finns även för den psykiska hälsan hos elitidrottare eftersom forskning har identifierat en rad idrottsspecifika stressorer som ökar risken för psykisk ohälsa. Self-efficacy är en annan faktor som har visats kunna påverka elitidrottarens idrottsliga prestation och är tillsammans med ett gott psykiskt mående viktigt för att elitidrottaren ska lyckas. Syfte: Att undersöka förekomst och grad av generaliserat ångestsyndrom (GAD) och self-efficacy (SE) till att nå idrottsspecifika mål hos unga svenska kvinnliga elitgymnaster samt dess korrelation. Metod: Studien är en tvärsnittsstudie med en kvantitativ ansats. Generaliserat ångestsyndrom mättes med en elektronisk version av GAD-7 och SE med General Self-Efficacy Scale (GSES). Deltagarna rekryterades genom ett icke slumpmässigt bekvämlighetsurval och datan analyserades i det statistiska dataprogrammet SPSS. Resultat: 48 deltagare rekryterades till studien och av dessa rapporterade 54,3 % någon grad av GAD. Deltagarna hade ett medianvärde på 29 poäng för SE till att nå idrottsspecifika mål. Det fanns en signifikant, svag och negativ korrelation mellan GAD och SE till att nå idrottsspecifika mål. Konklusion: Studiens resultat går i linje med tidigare forskning som visar att GAD är vanligt förekommande hos kvinnliga elitidrottare. Ett svagt negativt samband kunde visas mellan GAD och SE till att nå idrottsspecifika mål hos de unga, kvinnliga svenska elitgymnasterna. Dock behövs mer forskning på en större population rekryterade från ett slumpmässigt urval för att resultatet ska kunna generaliseras. / Background: Mental illness is a common health problem among young Swedish women. There is also a growing interest for the mental health of elite athletes as previous research has identified several sport-specific stressors that can increase the risk of mental illness. Self-efficacy is another factor that has been shown to affect athletic performance and is, as well as a good mental state, important for an elite athlete to succeed.  Aim: To investigate the prevalence and severity of generalized anxiety disorder (GAD) and self-efficacy (SE) to achieve sport-specific goals in young Swedish female elite gymnasts and its correlation. Methods: The study is a cross-sectional, non-randomized study with a quantitative approach. GAD was measured using an electronic version of GAD-7 Scale and SE with the General Self-Efficacy Scale (GSES). Results: 48 participants were recruited and out of these, 54,3% reported some degree of GAD. The participants had a median value of 29 points for SE to achieve sport-specific goals. There was a significant, weak and inverse correlation between GAD and SE to achieve sport-specific goals. Conclusion: The results of the study are in line with previous research that identifies GAD as a common health problem among female elite athletes. A significant, weak and inverse correlation could be shown between GAD and SE to achieve sport-specific goals. However, more research is needed on a larger population recruited from a randomized sample for the results to be generalized.

Generalized anxiety disorder (GAD) is a prevalent anxiety disorder that is characterized by persistent excessive worrying that is often difficult to control. The pathology of GAD has been associated with abnormal neural activity and functional connectivity. This systematic review has examined the central neural correlates of GAD which are the prefrontal cortex (PFC), the anterior cingulate cortex (ACC) and the amygdala and how activation and functional connectivity in these brain areas differ between patients with GAD and healthy controls. This review also investigated how abnormal functional connectivity and activation in these brain regions relates to worry which is the most prominent psychological symptom in patients with GAD. A systematic review was conducted and seven original functional magnetic resonance imaging (fMRI) studies were included after a literature search on PubMed, Scopus and, Web of Science. The main findings from this review revealed decreased activation in the PFC and ACC and enhanced activation in the amygdala during the viewing of negative stimuli in patients with GAD. Identifying the neural correlates of GAD and how it relates to worry may provide improved treatment in the future such as developing more effective psychotropic drugs or improved psychotherapy. GAD has been associated with lower well-being and life satisfaction and may even be a risk factor for suicidal thoughts. One of the limitations from this review is that several of the included studies recruited patients with comorbidities and for that reason results from these studies cannot be generalized and applied to individuals with GAD.

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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.

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