This study explored inhibitory control in spider phobic (SP) and healthy control (HC) individuals using an emotional antisaccade task. Attentional control theory (ACT) suggests anxiety related deficits in inhibitory control, yet studies on antisaccade performance in anxiety disordered patients are sparse. This study addressed this research gap and additionally aimed to explore putative associations of antisaccade performance with multimodal measures of fear of spiders.

Avoidance of potentially dangerous contexts is beneficial for survival (i.e., adaptive avoidance), but the generalization of avoidance behavior to other generally safe contexts (i.e., maladaptive avoidance) can lead to detrimental mental health consequences, including diminished potential for reward. Decisions around pursuing reward in the presence of threat or avoiding threat at the cost of obtaining greater reward presents an approach-avoidance conflict (AAC). Although AAC is expected to be biased among trauma-exposed adults, especially those with posttraumatic stress disorder (PTSD), there have only been two prior behavioral investigations of AAC among adults with PTSD or experiencing PTSD symptoms. While greater levels of physical activity (PA) contribute to enhanced cognitive performance during reward-based decision-making tasks, it remains unknown whether greater PA also offers a protective effect or rather dampens the potential for greater AAC and sacrifice of reward in the presence of threat. The current study administered a trauma-related AAC behavioral task to trauma-exposed adults with varying PTSD symptom severity (N = 93), to examine potential interactive relationships between PTSD symptom severity, PA, and AAC decision-making under threat. The task involved a total of 150 trials and was divided into two phases: congruent (the option with the highest probability of a positive point outcome was also the option that was least likely to result in the presentation of a trauma-related image), and conflict (the option with the highest probability of a positive point outcome was also the option that was most likely to result in the presentation of a threat-related image). Results from linear mixed effects models revealed that PA moderated the relationship between PTSD symptom severity and AAC, as we observed a positive relationship between PTSD symptom severity and AAC for lower PA volume (i.e., greater conflict), and a more negative relationship between PTSD symptom severity and AAC as PA volume increased (i.e., less conflict). These results suggest that greater PA may promote a greater propensity to engage in goal-directed behavior and seek reward in the presence of threat in those with greater PTSD symptom severity.

This study presents nationally representative findings on the epidemiology of generalized anxiety disorder (GAD) among Bangladeshi adults, based on data from a nationwide household survey. Participants were initially screened using the Self-Reporting Questionnaire (SRQ), and those screening positive underwent face-to-face clinical interviews by trained psychiatrists. Diagnoses were established using DSM-5 criteria. A total of 7270 adults completed all measures used in this survey. The weighted lifetime prevalence of GAD was 3.5 % (95 % CI: 2.9-4.2), with higher rates observed among women (4.2 %) and rural residents (3.7 %) compared to men (2.7 %) and urban residents (2.8 %). Significant correlates included female sex (OR = 1.62, p = 0.012), lower educational attainment (OR = 2.42-3.49, p < 0.05), and a family history of mental illness (OR = 2.56, p = 0.004). Despite the substantial burden, the treatment gap remained alarmingly high, with only 3.9 % of individuals with GAD seeking professional help. Individuals with a family history of mental illness were significantly more likely to seek treatment (OR = 8.32, p < 0.001) for GAD, while no significant associations were found with other sociodemographic factors. These findings highlight the need for community-based awareness programs, the integration of mental health services into primary care, a focus on high-risk groups, and the strengthening of the mental health workforce to address the substantial burden of GAD and reduce the pervasive treatment gap in Bangladesh.

Social anxiety disorder (SAD), body dysmorphic disorder (BDD), and major depressive disorder (MDD) are highly comorbid, which may be influenced by cultural variables associated with individualism vs. collectivism with particular emphasis on shame. This study investigated the network structures comprising symptoms of SAD, BDD, MDD, and shame across three countries typically associated with either a high tendency of collectivism (Japan), a high tendency of individualism (USA), or in between (Germany). Participants included 319 Japanese, 440 US Americans, and 308 Germans from the general populations of their respective countries, who completed questionnaires assessing the aforementioned symptoms as well as individualistic and collectivistic tendencies. Psychometric network analyses were conducted using Gaussian Graphical Models to separately examine the network structures of (a) individualistic and collectivistic tendencies and (b) symptoms of SAD, BDD, MDD, and shame. A Network Comparison Test (NCT) was used to assess the overall consistency of these networks across countries. The NCT revealed significant cross-cultural differences in the network structures of individualistic and collectivistic tendencies across countries, as well as in the networks of symptoms of SAD, BDD, MDD, and shame between Japan and Germany and between Japan and the USA. Although certain central symptoms were shared across all countries, others differed. These findings underscore the coexistence of cultural homogeneity and heterogeneity in the manifestation and organization of SAD, BDD, and MDD symptoms, emphasizing the importance of culturally sensitive, targeted interventions.

Approximately one in five (19.5 %) young adults have experienced generalized anxiety disorder (GAD) in the past year. Compared with other age groups, they are least likely to receive mental health treatment despite reporting greater need for these services. To address these issues, we conducted a randomized clinical trial with 102 young adults using an 8-week, automated text-message delivered cognitive behavioral therapy (CBT-txt-A) to treat GAD. We examined treatment engagement, tested treatment efficacy, and tested 3 clinical mechanisms of change. Participants were from 33 states, recruited from Instagram and Facebook who presented with at least moderate GAD symptomatology. Assessments occurred at baseline prior to randomization and at 1, 2, and 3 months after enrollment. The primary outcome, severity of GAD symptoms, was assessed using the GAD-7 measure. Behavioral activation, perseverative thinking, and cognitive distortions were hypothesized clinical mechanisms. Participants were randomized to CBT-txt-A or a waitlist control condition. Results indicated that participants in the CBT-txt-A group significantly reduced their GAD symptoms over time compared to the control condition, producing a large effect size (Cohen d = 0.83). One quarter of the treatment group moved into the high-end state functioning level, representing no or minimal GAD symptoms, compared to 5.5 % of the controls. Mediation analyses indicated that CBT-txt-A increased behavioral activation, and reduced perseverative thinking and cognitive distortion, at 2 months, which in turn, was then associated with reductions in GAD symptoms at 3 months. Results provide evidence for the efficacy of CBT-txt-A in reducing GAD symptoms through three hypothesized clinical mechanisms.

Clinician training is often not sufficient to increase the adoption of evidence-based psychotherapies (EBPs). To address organizational barriers that may limit use of EBPs, a tailored implementation strategy-Targeted Assessment and Context-Tailored Implementation of Change Strategies (TACTICS)-was developed. TACTICS involved external facilitation (appointing a local implementation team and external coach, conducting need assessment interviews, creating site-specific implementation plans, and weekly coaching for the site champion) augmented with a planning rubric and resources for making operational changes. The effect of adding TACTICS after clinician training was evaluated in a cluster-randomized stepped-wedge trial across eight military treatment facilities. Psychotherapists (n = 212) received training in prolonged exposure (PE) therapy. TACTICS was subsequently introduced with timing randomized by site. PE utilization was measured via natural language processing of notes from 26,429 psychotherapy encounters across 3459 patients. After accounting for time effects, TACTICS increased PE use compared to training alone (OR = 1.05-2.21, p < .03). Nonetheless, overall use of PE declined over time (OR = 0.067-0.316, p < .001). In post-hoc analyses, declining use of PE over time was strongly associated with a decreasing supply of psychotherapy appointments per patient (r = .98). These findings suggest that local implementation support improves EBP adoption beyond training alone. However, lasting use may require broader system supports such as adequate staffing and policies that encourage use of EBPs.

The aim of the present study was to assess the measurement invariance of the long version of the straightforwardly-worded Social Interaction Anxiety Scale (S-SIAS) across 10 countries and explore links with life satisfaction in a large sample of emerging adults attending university. Participants were N = 4284 university students (M = 19.89 years, SD = 1.83; 65 % females) from 10 countries (i.e., Argentina, Australia, Canada, China, India, Italy, South Korea, Norway, Turkey, and the United States), who completed self-report assessments of social anxiety and life satisfaction. Findings from a multiple-group factor analysis alignment method indicated approximate measurement invariance for the S-SIAS across the 10 country sites. University students from Norway reported the highest mean level of social anxiety of all groups, whereas participants from Argentina reported the lowest social anxiety. Results from multigroup regression analysis indicated that social anxiety was negatively associated with life satisfaction in all samples (except for Argentina and Australia, where the life satisfaction measure was not collected), but the strength of the association was stronger in Norway compared to samples from other countries. Results are discussed in terms of the meaning and implication of social anxiety across cultures.

Emetophobia, the specific fear of vomiting, is a poorly understood anxiety disorder. Despite a growing body of research, comprehensive reviews on its presentation and assessment are limited and dated. This scoping review maps, synthesises and explores existing literature on the assessment measures and symptomatology of emetophobia. Its purpose is to inform future clinical practices by identifying reliable assessment instruments and facilitating more accurate diagnosis, treatment planning, and research comparisons. Five online databases (PubMed, SCOPUS, PsycINFO, Google Scholar, PsyArXiy) were searched using terms related to emetophobia. In total, 483 unique articles were located of which 38 were eligible for inclusion (35 described symptomatology; 3 described assessment measures). Among studies exploring symptoms, 17 were single case studies, 11 were cross-sectional surveys and 7 were other designs (e.g., case series, retrospective studies). Findings indicate that emetophobia is a multifaceted condition consisting of physical, psychological and behavioural symptoms. Avoidance behaviours are the most frequently reported symptom, described in 91 % of included literature. There is little research exploring the differences in child and adult symptom presentation which may result in misdiagnosis if an adult-centric criteria is applied. Two self-report questionnaires have been created and their psychometric properties assessed but, given numerous studies relied on longer, unvalidated assessment measures, these two measures appear to need further development. This review establishes that emetophobia is a complex and debilitating condition impacting multiple domains of life. Its findings will inform future research into the development and evaluation of tailored interventions targeting the specific presentation of emetophobia.

The Posttraumatic Stress Disorder (PTSD) Checklist for the DSM-5 (PCL-5) has demonstrated excellent psychometric qualities across cross-sectional studies, yet the scale's performance in intensive longitudinal studies is less known. Using data from the PCL-5 administered daily for 9 days, we (a) conducted item analysis of the PCL-5 using the graded response model to examine item characteristics (thresholds and discrimination parameters) and (b) examined differential item functioning (DIF) to evaluate whether the PCL-5 measured the PTSD latent trait identically across daily surveys (i.e., longitudinal measurement invariance). Methodologically, 256 trauma-exposed university students (Mage = 21.01 ± 4.24; 85.8 % women; 41.0 % probable PTSD) completed the 20-item PCL-5 for 9 consecutive days. Across days, results indicated lower but acceptable discrimination for PCL-5 items 8 (traumatic amnesia), 16 (reckless or self-destructive behaviors), and 17 (hypervigilance). Further, 14 % of participants exhibited person misfit at least once across the 9 days. DIF analysis indicated that Item 2 (nightmares) exhibited DIF across days indicating potential bias; however, the effect sizes for DIF were negligible. In conclusion, the results broadly provide psychometric support for using the 20-item PCL-5 in intensive longitudinal studies. Future replication of study results across diverse and clinical populations could help to further strengthen these findings.

Academic achievement is an important predictor of later life outcomes, yet its relationship with anxiety disorders and obsessive-compulsive disorder (OCD) remains unclear. This systematic review and meta-analysis aimed to clarify the direction and strength of these associations and is the first to synthesise evidence on moderators and mediators.

Sleep disturbances have been linked to generalized anxiety disorder (GAD) symptoms. However, cross-sectional studies, linearity assumptions, and limited predictor sets preclude identifying which unique sleep disturbance markers precede GAD symptoms. We thus harnessed machine learning (ML) to determine objective and subjective sleep disturbance predictors of nine-year GAD symptoms.

Prevailing models of posttraumatic stress disorder (PTSD) suggest that trauma-related cognitions have a critical role in influencing the persistence of posttraumatic stress symptoms. This study aimed to quantitatively synthesise the strength of the relationship between changes in trauma-related cognitions and PTSD severity in response to trauma-focused psychotherapy (T-F psychotherapy). We also sought to explore potential moderators of this relationship. Four databases (PubMed (includes MEDLINE), PsycINFO, PTSDpubs (formerly PILOTS), and Cochrane library) were searched for relevant studies. Additional 'hand search' strategies were conducted to obtain relevant articles that may have been missed in the original database searches. A total of 44 studies reporting 95 effect sizes with data from 5102 participants were extracted. Primary analyses indicated that pre-post reductions in trauma-related cognitions were significantly related to pre-post reductions in PTSD severity, r = .45 (95 %CI [.40,.49], p < .0001). Additionally, mid-treatment reductions in trauma-related cognitions were significantly associated with mid-treatment reductions in PTSD severity, r = .42 (95 %CI [.34,.50], p < .0001). Exploratory moderator analyses did not yield any significant findings of this relationship between changes in trauma-related cognitions and PTSD severity. Secondary analyses revealed that reductions in trauma-related cognitions after T-F psychotherapy were similalry related to reduced PTSD severity after treatment, r = .49 (95 %CI [.40,.57], p < .0001). These findings underscore the importance of reductions in trauma-related cognitions as a potential key indicator of PTSD symptom reduction throughout varied points of T-F psychotherapy. The implications for augmenting outcomes of T-F psychotherapy are discussed.

Individuals with Posttraumatic Stress Disorder (PTSD) exhibit symptoms that affect their responsiveness to negative information. Specifically, hypervigilance heightens attention toward negative stimuli, whereas dissociation diverts attention away from it (Chiba et al., 2021), potentially leading to differential effects on memory encoding. This study investigated the influence of prominent hypervigilant and dissociative symptomatology on the memorization of negative emotional and contextual information in individuals exposed to the November 13, 2015, Paris terrorist attacks. Participants included individuals who had been exposed to the traumatic event (N = 99; 26 met full diagnostic criteria for PTSD, 28 showed subthreshold symptoms, and 45 had no symptoms) and non-exposed individuals (N = 65). They were asked to memorize faces displaying positive, neutral, and sad emotions, each paired with a word representing a profession, which served as a non-emotional contextual cue. This task was administered at two time points: ∼1.5 years and ∼3.5 years after the attacks. An emotion-profession recognition task was used, with an index measuring whether the emotional expression or the profession was better recognized. At the first time point, among exposed individuals, a relationship was observed between the prominence of hypervigilant or dissociative symptoms and enhanced recognition of either the emotional expression or the profession, respectively, in the context of sad facial expressions. Furthermore, changes in the prominence of these symptoms between the two time points were associated with shifts in the type of content that was better recognized. Collectively, these findings suggest the presence of a memory bias-either toward or away from emotional content-among individuals exposed to traumatic events, and particularly those with full diagnostic criteria for PTSD.

Imminent threat does not only capture attention but also triggers defensive psychophysiological responses associated with fight-flight-freeze behavior. However, within-subject associations between central markers of attentional stimulus processing and peripheral components of early defensive activation (e.g., cardiac acceleration) are not well understood. These associations may be especially important in understanding dynamics of anxiety disorders that are characterized by cardiovascular symptoms such as panic disorder.

As anxiety disorders are common and clinically significant psychiatric disorders in children and adolescents linked to a broad spectrum of psychiatric problems, we need valid assessment instruments of anxiety. The Screen for Child Anxiety Related Emotional Disorders (SCARED) is widely used to assess anxiety symptoms. However, its factor structure remains debated, and its psychometric properties are underexplored in China. This study examined the factor structure of the SCARED and its measurement invariance across gender, age, and time among Chinese students. Specifically, this study used a two-wave longitudinal design, with a six-month interval (Time 1: December 2019-January 2020; Time 2: June 2020-July 2020). Data included 6176 children and adolescents aged 8-19 years (51.6 % boys; mean age = 11.52, SD = 1.62) from Sichuan, China. Confirmatory factor analyses supported a five-factor model as the best fit. Measurement invariances across gender, age, and time were established at the configural, metric, scalar, error variance, factor variance, and factor covariance levels, as supported by changes in the comparative fit index (CFI ≤ 0.004) and root mean square error of approximation (RMSEA ≤ 0.002). Furthermore, structured means modeling analyses showed that girls experienced more anxiety than did boys. Children experienced higher separation anxiety but lower general anxiety and school phobia than did adolescents. Moreover, participants experienced fewer anxiety symptoms at Time 2. Overall, the SCARED was valid and reliable for measuring anxiety symptoms in Chinese children and adolescents, confirming its utility as an objective outcome measure.

Youth anxiety disorders are common and heterogeneous. The Pediatric Anxiety Rating Scale (PARS) is a clinician-administered tool designed to assess overall anxiety severity, independent of specific symptoms. The thresholds on PARS for the reliable change index (RCI), the minimal clinically important difference (MCID), treatment response, and full and partial remission remain unclear. Using the Clinical Global Impression (CGI) scales and diagnostic interviews as benchmark measures, several thresholds for the 6-item PARS were estimated using data from 904 youth with anxiety disorders, of which 36 % had an autism diagnosis. Data were drawn from 9 clinical trials conducted in the United States. Threshold accuracy was evaluated in a holdout sample and in an independent Swedish sample (n = 49). The reliable change index (RCI) was 3.39 points. A raw score reduction of ≥ 4 points or a ≥ 20 % reduction best defined the MCID. A raw score reduction of ≥ 8 points or a ≥ 43 % reduction best defined treatment response. Scores of 0-10 after treatment accurately defined full and partial remission, and scores of 0-5 defined full remission. Threshold accuracies ranged from 74-91 % in the holdout and 67-78 % in the Swedish sample. Treatment response accuracy was similar across samples, while MCID accuracy was lower in the Swedish sample. Similar cutoffs emerged in youth with and without autism and across age groups and genders. Threshold accuracies for the 5- and 7-item PARS versions were comparable to the 6-item version. This study establishes response and remission thresholds for PARS that are applicable across age groups, genders, and autism status. We advise against using the RCI as it does not exceed the MCID.

This is the first randomised controlled trial (RCT) to examine the efficacy of intensive internet-delivered CBT (iCBT) for social anxiety disorder (SAD). Adults (mean age: 44.77 years, 75.4 % female) diagnosed with SAD were randomly allocated to iCBT (n = 33) or a waitlist control group (WLC; n = 28). The iCBT group received a clinician-guided, six lesson program delivered online over seven days. Participants completed self-report measures of social anxiety and depression symptoms, and functional impairment at two- (post-treatment) and six-weeks post-baseline (one-month follow-up), and a diagnostic interview to assess SAD and major depressive disorder (MDD) at baseline and one-month follow-up. The iCBT group reported significantly lower social anxiety symptoms (Hedges' g's > .96), and functional impairment at post and one-month follow-up (g's > .59), but there were no significant differences in depression symptoms (g's = .42). Participants in the iCBT group were less likely to continue to meet criteria for SAD (47.6 %) at follow-up compared to WLC (96.4 %). Adherence (83.9 % completion) and program satisfaction (85.2 % reported being 'mostly' or 'very satisfied') were promising. Delivering iCBT over an intensive treatment period is feasible and acceptable to participants with SAD and showed promise for reducing social anxiety and functional impairment. Further research is needed to compare intensive iCBT with active control groups, using a larger and more diverse sample and longer-term outcomes.

Digital therapeutics (DTx) have emerged as scalable and accessible treatment modalities for panic disorder.

Deficits in positive emotion regulation (PER) contribute to emotional disorders but are less studied than negative emotion regulation (NER). One maladaptive PER strategy, positive emotion contrast-seeking (PEC-seeking), involves sustaining negative affect to enhance later positive emotions, reinforcing anxiety and depression. This study developed and tested a savoring-based, transdiagnostic intervention to reduce PEC-seeking and alleviate emotional disorder symptoms. A single-blind RCT with 59 Chinese college students with elevated depression and anxiety (majority meeting depression criteria) compared a two-week group savoring meditation intervention to waitlist control. Changes in depression, anxiety, savoring beliefs, and PEC-seeking were assessed at Baseline (T0), MidTest (T1), PostTest (T2), and one-month Follow-up (T3). The experimental group also reported positive and negative affect before and after each group session and individual practice. Savoring meditation significantly reduced depression (T1, d = -1.11, p = .005; T2, d = -1.60, p < .001) with effects maintained at follow-up (T3, p < .001). Negative affect also declined significantly (Session 5, p < .001), though changes in positive affect were not statistically significant. The intervention increased savoring beliefs (T1, d = 1.42, T2, d = 1.41, ps =.003) and reduced PEC-seeking (T1, d = -0.92, p = .027), which in turn mediated reductions in depression. Although anxiety symptoms declined within the experimental group over time, between-group differences did not reach statistical significance. Nonetheless, the effect size was larger for the experimental group (T2, d = 0.34) than for the waitlist group (d = 0.01), suggesting a potential anxiolytic effect of the intervention. These findings suggest that targeting maladaptive PER strategies, especially PEC-seeking, via savoring meditation may effectively reduce emotional disorder symptoms. This study highlights PER's role in transdiagnostic interventions and provides novel insights into PER-focused therapies.

This study empirically tested several predictions arising from the Memory and Identity (M&I) Theory of ICD-11 Complex PTSD (CPTSD). Specifically, it examined the psychometric properties of two measures-the Experiences of Traumatic Memories Questionnaire (ETMQ) and the Trauma Identity Questionnaire (TIQ)-and tested relationships between different types of trauma exposure, disturbances in memory and identity, and CPTSD symptoms.

Panic disorder (PD) is a chronic and impairing anxiety disorder. Individuals with more sleep disturbances might be predisposed to nine-year PD chronicity. However, linearity assumptions, small predictor sets, and analytic and design limitations have hindered optimal identification of which sleep disturbance variables are distal risk factors for PD chronicity. We thus used machine learning (ML) to predict nine-year PD chronicity using high-dimensional data.

Despite a growing body of literature, understanding of the relationship between maternal symptoms of perinatal posttraumatic stress disorder (PTSD) and the emerging mother-infant bond (MIB) remains limited. This systematic review and meta-analysis elucidates this association considering both general PTSD (gPTSD) symptoms (i.e., not originating from childbirth) as well as childbirth-related PTSD (CB-PTSD) symptoms.

Interpersonal reassurance-seeking is a common anxiety-management strategy used by individuals with a range of disorders, but can be particularly repetitive and exacting among individuals with obsessive-compulsive disorder (OCD). Although this strategy yields short-term relief, it also comes at a cost, creating frustration and straining relationships. Non-interpersonal sources of reassurance-such as the internet-have been less thoroughly studied, but may offer unique advantages. In this mixed-methods study, we explored the differentiating benefits and drawbacks of interpersonal and online reassurance-seeking for individuals with and without OCD. Participants (n = 62 OCD, n = 58 control) completed an imaginal exposure task, after which they indicated their reassurance source preference (interpersonal vs. online) and their primary reasons for this preference. Participants also answered two general questions about their usual motivations for seeking reassurance from each source at the exclusion of the other. We used content analysis to identify patterns in participants' responses, and quantitative methods to examine the most common motivations as well as any between-group differences. Common reasons for seeking reassurance interpersonally included desires for emotional support and personalization, and these findings did not differ between groups. Common reasons for online reassurance typically involved interpersonal concerns, and participants with OCD were more likely to specifically express concern about the personal consequences of revealing one's worries to others. Motivations related to trust and seeking shared experiences were common for both reassurance types. These findings are discussed in the context of the broader literature on reassurance-seeking and obsessive-compulsive symptomatology.

Substance use disorders have been linked to Generalized Anxiety Disorder (GAD), though much of this research predates DSM-5 diagnostic criteria. Further, little prior work has examined the demographic correlates of specific substance use disorders among individuals with GAD. These demographic correlates, as well as the presence of comorbid substance use disorder, may also impact treatment seeking in individuals with GAD. In the present study, we explored the relationship between GAD and common substance use disorders (Alcohol Use Disorder, Cannabis Use Disorder, and Tobacco Use Disorder), as well as the demographic factors associated with these disorders among individuals with GAD in a large, nationally representative sample. We also tested whether each of these substance use disorders were associated with GAD-related treatment seeking. Controlling for demographics and comorbidities, lifetime GAD was positively associated with lifetime Alcohol and Cannabis Use Disorder, but not Tobacco Use Disorder, whereas past-year GAD was positively associated with past year Cannabis and Tobacco Use Disorder but not past year Alcohol Use Disorder. Lastly, lifetime Alcohol Used Disorder but not Cannabis or Tobacco Use Disorder was associated with higher rates of GAD-related treatment seeking. Collectively, these findings reflect an updated examination of GAD and disordered substance use using DSM-5 diagnostic criteria and indicate the importance substance use comorbidities in the context of GAD.

Adolescence is a key period in which anxiety symptoms dramatically increase, particularly among adolescent girls. Identifying potentially-modifiable risk factors that contribute to anxiety symptoms may be critical to mitigate anxiety symptoms and disorders among youth. Attention biases are one set of cognitive risk factors implicated in the development and maintenance of anxiety disorders. Yet previous research remains mixed as to what pattern of attention bias characterizes adolescents at-risk for developing anxiety. Further, prior literature has largely relied on indirect measures of attention (e.g., reaction time) and tasks with low ecological validity. The present study investigated how attention to social evaluative feedback contributed to concurrent and prospective anxiety symptoms in adolescent girls (n = 90, baseline M = 12.31, SD =.83). The present study used a novel speech task and mobile eye-tracking technology to assess gaze-directed attention in an ecologically valid context that adolescents encounter daily. We hypothesized that adolescents who engage in vigilance, avoidance, and the combination of vigilance-avoidance of potentially critical social evaluative feedback would report greater concurrent and prospective anxiety symptoms. We also explored the association between gaze-directed attention to positive social feedback. Contrary to our hypotheses, adolescents who exhibited both initial and sustained avoidance of potentially critical social feedback reported the greatest anxiety three-years later, controlling for baseline anxiety symptoms. Findings highlight the importance of avoidance in real-world socially threatening scenarios in contributing to and maintaining anxiety. Findings also highlight the value of studying attention biases that contribute to anxiety symptoms among adolescents using reliable methods and in real-world contexts.

Tonic immobility (TI) is a profound paralysis that may occur during extreme stress. Previous studies have found that TI during trauma was associated with poorer recovery from posttraumatic stress disorder (PTSD). Importantly, TI can re-occur during re-experiencing the trauma (TI). It is unclear whether TI also hinders recovery from PTSD or declines along with other PTSD symptoms after treatment. We examined whether pre-treatment self-reported TI would predict PTSD symptoms after trauma-focused treatment, including related constructs as depression and dissociation. and investigated pre- to post-treatment changes in TI. We also explored individual differences in TI course. A total of 257 patients with PTSD, referred to a clinic for intensive trauma-focused therapy, completed measures for PTSD symptoms and TI at pre- and posttreatment, and potential confounding variables (dissociative tendencies, somatoform dissociation, dissociative subtype, and depression) at pre-treatment. Higher pre-treatment TI predicted elevated post-treatment PTSD symptoms, but not after controlling for potentially confounding constructs. Overall, TI decreased from pre- to post-treatment, and a greater decrease in TI was associated with a greater decrease in PTSD symptoms. However, four distinct clusters could be identified, which differed in TI course: High-stable, High-decrease, Moderate and Low TI. End-state was worse for patients in the High-stable and Moderate clusters. Thus, in the general sample, pre-treatment TI was not associated with reduced recovery, and TI generally decreased after treatment, suggesting that TI may be related to the PTSD symptomatology, responding well to trauma-focused CBT treatment. However, TI may not decline in specific patient groups. Future research may address how TI can be targeted for these patients.

Safety behaviors (SBs) are hypothesized to play a key role in social anxiety and present as a viable target of psychosocial treatments. While SB reduction is a component of some cognitive-behavioral therapies for social anxiety, prior research suggests safety behavior fading also represents a viable, standalone digital treatment for social anxiety. The aim of the present study was to test a one-month self-monitoring SB treatment in individuals reporting elevated social anxiety symptoms against a credible control condition. Participants (N = 201) were randomized to either a SB fading condition (n = 99) or an unhealthy behavior fading control (n = 102). Compared to control, SB fading led to lower SB use at post but not one-month follow-up. Contrary to predictions, both conditions saw significant and comparable reductions in social anxiety and related outcomes (depression, loneliness) at posttreatment and follow-up. Treatment credibility and expectancy moderated the effect of condition, such that among participants with more positive beliefs about treatment (after being provided with the rationale), those in the SB condition reported significantly lower follow-up social anxiety than those in control. Further, in the SB condition, both higher social interaction frequency and lower loneliness at baseline were predictive of lower social anxiety at follow-up. Overall, our findings show limitations to SB fading as a standalone intervention and suggest this strategy is more effective among those who interact with others more frequently and who are more confident in this treatment approach. We discuss clinical implications and future research directions, including potential refinements to SB treatment protocols.

Social anxiety disorder is a pervasive clinical disorder characterised by intense fear and/or avoidance of one or more social situations, and has been linked to deficits in executive functioning performance. However, methodological differences and mixed results have made it difficult to draw definitive conclusions from individual studies. The current systematic review and meta-analysis collated the results from 49 studies to examine the link between social anxiety disorder and executive functioning across the lifespan. Findings revealed that individuals with social anxiety performed significantly worse than healthy controls or low social anxiety groups on measures of executive functioning (r = -.15), specifically cognitive flexibility (r = -.20), inhibitory control (r = -.18), and global executive functioning (r = -.17). No significant association was evident between working memory and social anxiety (r = -.06). In addition, the type of measure (self-report vs cognitive task) moderated the relationship between social anxiety and executive functioning. Although age did not moderate the overall relationship, the association between the individual domains of executive functioning and social anxiety differed between youth and adults, which may reflect the different developmental timelines between the domains across the lifespan. The findings offer valuable insight into our understanding of the development of executive functions for individuals with social anxiety and could assist with forming new strategies or interventions to improve daily functioning in this clinical population.