Relationships between metacognitive beliefs and anxiety and depression in children and adolescents: A meta-analysis.

BACKGROUND: As hypothesized in the Self-Regulatory Executive Function (S-REF) model, metacognitive beliefs are associated with anxiety and depression in adults. An important question is the extent to which such effects are present in children and adolescents, with the implication that the model may also apply to young people. The aim of this meta-analysis was to synthesize results on the nature and magnitude of associations between metacognitive beliefs and anxiety and depression in children and adolescents. METHODS: Systematic searches were conducted to identify studies that investigated: (1) group differences in metacognitive beliefs in clinical compared to non-clinical samples or (2) correlations between metacognitive beliefs and symptoms of anxiety and depression. RESULTS: Forty papers were identified comprising a total sample of 9,887 participants aged 7-18 years. Meta-analyses revealed that clinical samples endorsed significantly elevated metacognitive beliefs on four out of the five domains measured (i.e., negative beliefs about worry, cognitive confidence, need for control, and cognitive self-consciousness, with the only exception being positive beliefs about worry) compared to non-clinical samples with a small to large effect (Hedges' gs = 0.45-1.22). Moreover, all five domains of metacognitive beliefs were significantly and positively correlated with symptoms of anxiety and depression of a small to large effect (rs = .24-.53). Negative beliefs about worry showed the strongest relationship with clinical status and the magnitude of symptoms. LIMITATIONS: The number of studies did not allow for an evaluation of metacognitive beliefs at a disorder-specific level. CONCLUSIONS: In line with the S-REF model, our findings provide evidence of robust cross-sectional relationships between metacognitions and both anxiety and depression in childhood and adolescence.

The effect of experimental emotion induction on experimental pain: a systematic review and meta-analysis.

ABSTRACT: The idea that emotions can influence pain is generally recognized. However, a synthesis of the numerous individual experimental studies on this subject is lacking. The aim of the present systematic review and meta-analysis was to synthesize the existing evidence on the effect of experimental emotion induction on experimental pain in nonclinical adults. PsycInfo and PubMed were searched up until April 10, 2023, for studies assessing differences in self-reported pain between emotion induction groups and/or control groups or between conditions within group. Risk of bias was assessed for the individual studies. The literature search yielded 78 relevant records of 71 independent studies. When compared with control conditions, the pooled results revealed a statistically significant pain-attenuating effect of positive emotion induction (between-group: Hedges g = -0.48, 95% CI: -0.72; -0.25, K = 9; within-group: g = -0.24, 95% CI: -0.32; -0.15, K = 40), and a statistically significant pain-exacerbating effect of negative emotion induction in within-group analyses but not between-group analyses (between-group: g = -0.29, 95% CI: -0.66; 0.07, K = 10; within-group: g = 0.14, 95% CI: 0.06; 0.23, K = 39). Bayesian meta-analysis provided strong support for an effect of positive emotion induction but weak support for an effect of negative emotion induction. Taken together, the findings indicate a pain-attenuating effect of positive emotion induction, while the findings for negative emotion induction are less clear. The findings are discussed with reference to theoretical work emphasizing the role of motivational systems and distraction for pain. Limitations include considerable heterogeneity across studies limiting the generalizability of the findings.

The effect of age on emotion regulation patterns in daily life: Findings from an experience sampling study.

The present experience sampling study investigated the effect of age on emotion regulation patterns (i.e., emotion regulation strategy effectiveness, variability, and differentiation) in daily life. The study further explored the implications of potential age differences in emotion regulation patterns for well-being. A sample of 406 adults (age range: 18-81, 62.8% female) were prompted five times a day for seven days to rate momentary emotions, emotion regulation strategy use, and emotion regulation strategy effectiveness. Based on these ratings, indicators of emotion regulation variability and differentiation were calculated. Well-being outcomes included daily positive and negative emotions, and symptoms of depression and anxiety assessed at baseline. The findings revealed reduced emotion regulation variability with age and a negative association between emotion regulation variability and well-being. There were no associations between age and emotion regulation effectiveness or differentiation. Emotion regulation effectiveness was associated with more positive and less negative daily emotions, and these associations were stronger for younger adults compared to older adults. Drawing on prominent lifespan theories, the findings may indicate that as people age, they select and apply a few strategies that they know will be effective given the context and their resources which leads to reduced emotion regulation variability but ultimately more well-being. Concerning emotion regulation effectiveness, the findings suggest that effectiveness is less important for emotional well-being in daily life in older adulthood possibly because well-being is determined by other factors (e.g., less frequent and more predictable stressors) with age.

Caregiver fear of cancer recurrence: A systematic review and meta-analysis of quantitative studies.

OBJECTIVE: Fear of cancer recurrence (FCR) is reported by both cancer survivors and caregivers however less is known about caregiver FCR. This study aimed to (a) conduct a meta-analysis to compare survivor and caregiver FCR levels; (b) examine the relationship between caregiver FCR and depression, and anxiety; (c) evaluate psychometric properties of caregiver FCR measures. METHODS: CINAHL, Embase, PsychINFO and PubMed were searched for quantitative research examining caregiver FCR. Eligibility criteria included caregivers caring for a survivor with any type of cancer, reporting on caregiver FCR and/or measurement, published in English-language, peer-review journals between 1997 and November 2022. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) taxonomy was used to evaluate content and psychometric properties. The review was pre-registered (PROSPERO ID: CRD42020201906). RESULTS: Of 4297 records screened, 45 met criteria for inclusion. Meta-analysis revealed that caregivers reported FCR levels as high as FCR amongst survivors, with around 48% of caregivers reporting clinically significant FCR levels. There was a strong correlation between anxiety and depression and medium correlation with survivor FCR. Twelve different instruments were used to measure caregiver FCR. Assessments using the COSMIN taxonomy revealed few instruments had undergone appropriate development and psychometric testing. Only one instrument met 50% or more of the criteria, indicating substantial development or validation components were missing in most. CONCLUSIONS: Results suggest FCR is as often a problem for caregivers as it is for survivors. As in survivors, caregiver FCR is associated with more severe depression and anxiety. Caregiver FCR measurement has predominately relied on survivor conceptualisations and unvalidated measures. More caregiver-specific research is urgently needed.

Optimising psychological treatment for pain after breast cancer: a factorial design study protocol in Denmark.

INTRODUCTION: One in five breast cancer (BC) survivors are affected by persistent pain years after completing primary treatment. While the efficacy of psychological interventions for BC-related pain has been documented in several meta-analyses, reported effect sizes are generally modest, pointing to a need for optimisation. Guided by the Multiphase Optimization Strategy, the present study aims to optimise psychological treatment for BC-related pain by identifying active treatment components in a full factorial design. METHODS AND ANALYSIS: The study uses a 2×3 factorial design, randomising 192 women with BC-related pain (18-75 years) to eight experimental conditions. The eight conditions consist of three contemporary cognitive-behavioural therapy components, namely: (1) mindful attention, (2) decentring, and (3) values and committed action. Each component is delivered in two sessions, and each participant will receive either zero, two, four or six sessions. Participants receiving two or three treatment components will be randomised to receive them in varying order. Assessments will be conducted at baseline (T1), session by session, every day for 6 days following the first session in each treatment component, at post-intervention (T2) and at 12-week follow-up (T3). Primary outcomes are pain intensity (Numerical Rating Scale) and pain interference (Brief Pain Inventory interference subscale) from T1 to T2. Secondary outcomes are pain burden, pain quality, pain frequency, pain catastrophising, psychological distress, well-being and fear of cancer recurrence. Possible mediators include mindful attention, decentring, and pain acceptance and activity engagement. Possible moderators are treatment expectancy, treatment adherence, satisfaction with treatment and therapeutic alliance. ETHICS AND DISSEMINATION: Ethical approval for the present study was received from the Central Denmark Region Committee on Health Research Ethics (no: 1-10-72-309-40). Findings will be made available to the study funders, care providers, patient organisations and other researchers at international conferences, and published in international, peer-reviewed journals. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT05444101).

Mediators of acceptance and mindfulness-based therapies for anxiety and depression: A systematic review and meta-analysis.

Acceptance and mindfulness-based therapies have shown efficacy in the treatment of anxiety and depression. Arguably, acceptance and mindfulness-based therapies target core processes in anxiety and depression by increasing mindful attention, decentering, and acceptance. The present study identified randomized controlled trials of acceptance and mindfulness-based therapies for anxiety and depression. Specifically, we aimed to synthesize the indirect effect of the three putative mediators (i.e., mindful attention, decentering, acceptance) on anxiety and depression. Electronic searches yielded 4989 unique records, which were screened for eligibility by two independent raters, resulting in the identification of 33 eligible studies (30 independent trials). The overall pooled mediating effect of mindful attention, decentering, and acceptance was small to medium (r = 0.145, p < .001). Type of mediation analysis emerged as the only statistically significant moderator. Specifically, studies using correlation-based mediation approaches showed statistically significant mediating effects, while studies using causal time-lag analyses did not yield statistically significant mediating effects. Mediator specificity could not be established. In conclusion, putative mediators of acceptance and mindfulness-based therapies mediated treatment effects on anxiety and depression. Limitations in study number, designs, and statistical approaches employed restrict conclusions regarding specificity and causality.

The Constructionist Approach to Emotional Aging: Theoretical Insights and Predictions.

In this article, we introduce a constructionist approach to understanding emotional aging in adulthood. The purpose of the paper is to show how constructionism offers a promising avenue for gaining new insights into age-related changes in emotional experiences. We begin by introducing the constructionist theoretical framework and illustrating how constructionism may shape conceptualizations of emotional aging in adulthood. We compare the constructionist conceptualization of emotional aging with existing conceptualizations of emotional aging derived from prominent theories of emotional aging, focusing on how such conceptualizations highlight different aspects of emotional aging (e.g., different mechanisms) and overlook or downplay other aspects. We conclude by explicating what constructionism may offer research on emotional aging, including considerations of research agendas, study designs, and method of measurement.

Emotion regulation patterns: Capturing variability and flexibility in emotion regulation in an experience sampling study.

Variability and flexibility in emotion regulation (ER) are considered important ingredients in adaptive ER. Few attempts at operationalizing variability and flexibility in ER have been made. In two 10-day experience sampling studies (N = 51 and 39), healthy participants rated their momentary emotions and their ER efforts in response to those emotions. We evaluated the association between ER (i.e., between and within ER strategy variability and ER flexibility, operationalized as putatively adaptive, putatively maladaptive and total strategies) and measures of well-being (psychological distress, satisfaction with life) in general (person-level) and in everyday life (day-level). Higher within-variability indicated that a strategy was used more at some occasions and less at others. Higher between-variability indicated variation in the extent to which different strategies were engaged at the same time point. Overall, results were mixed, but in some instances, indicators of ER variability and ER flexibility were related to each other and measures of well-being differently. Total within ER variability was negatively associated with well-being at the person and day level. Putatively adaptive between and within ER variability were associated with less well-being at the person level. At the day level, putatively adaptive and maladaptive between ER variability and maladaptive within ER variability were negatively associated with well-being. Putatively adaptive ER flexibility was negatively associated with satisfaction with life. This study adds to the literature on indicators of variability and flexibility in ER and their potential adaptiveness. The results indicate that variability in ER could be a maladaptive property, but more research is needed to understand this in terms of putatively adaptive and maladaptive strategies. Future studies on the adaptiveness of these indicators should obtain more contextual information.

Emotion regulation in context: A naturalistic study of emotion regulation in response to everyday happy and sad memories during dysphoria.

BACKGROUND AND OBJECTIVES: Effective emotion regulation is an important marker of mental health. However, only a sparse number of studies have examined emotion regulation within the context of different emotion type and intensity levels among individuals with elevated depressive symptoms. METHOD: We investigated emotion regulation in response to happiness and sadness experienced in the context of everyday memories of 23 dysphoric and 20 non-depressed participants. Participants completed a diary indicating the intensity of these emotions when thinking about a personal memory, as well as their employment of five emotion regulation strategies at that moment. RESULTS: Multilevel models indicated that dysphoric and non-depressed individuals differed in how they employed three emotion regulation strategies depending on the intensity of the emotions. Relative to non-depressed individuals, dysphoric individuals employed greater brooding, expressive suppression, and memory suppression when experiencing less intense happiness, and employed more brooding for more intense sadness. These effects were maintained after controlling for habitual emotion regulation, and controlling for the opposite concurrent emotion. The findings suggest that dysphoric individuals adjust the use of emotion regulation strategies differently from non-depressed individuals depending on the intensity level of happiness and sadness experienced. These patterns may be indicative of reduced emotion regulation flexibility or fear of emotional shifts. LIMITATIONS: The sample consisted of mostly young women. CONCLUSIONS: Clinical implications, particularly concerning emotion-focused interventions, are discussed.

Age-group differences in instructed emotion regulation effectiveness: A systematic review and meta-analysis.

Several theories of emotional development in adulthood provide the rationale for anticipating enhanced emotion regulation effectiveness (i.e., successful, goal-consistent regulation of emotions) with age. However, the existing empirical evidence is ambiguous. The aims of the present systematic review and meta-analysis were to investigate age-group differences in instructed emotion regulation effectiveness, and to explore whether age-group differences in instructed emotion regulation effectiveness vary according to person factors (i.e., age gap between age groups, gender distribution), the specific strategy (i.e., type of emotion regulation strategy), and situational factors (i.e., intensity and type of emotion to-be-regulated, emotion regulation goal, experimental context). PsycINFO and PubMed were searched for studies assessing age-group differences in instructed emotion regulation effectiveness in physically healthy adults. The literature search yielded 18 relevant studies conducted in laboratories (n = 1,366) and no relevant studies conducted in naturalistic settings. The meta-analyses indicated no statistically significant overall age-group differences (g = -0.01, p = .878). A statistically significant small effect favoring older adults was identified in a subgroup meta-analysis of studies assessing attentional focusing (g = -0.22, p = .027), while no other statistically significant results were identified. Together, these findings, albeit limited to a laboratory setting, indicate that instructed emotion regulation effectiveness remains largely stable in adulthood. The findings are discussed with reference to theoretical work emphasizing age-related changes in motivation (e.g., Socioemotional Selectivity Theory) and resources (e.g., Strength and Vulnerability Integration model). Limitations include the small number of studies and the limited generalizability of the findings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Comparing negative emotion differentiation in young and older individuals: A picture-based study.

Life span theories suggest that emotional experiences become more complex (i.e., nuanced and differentiated) with age. Theoretically, the cause of this increased complexity has been proposed to be age-related changes in life contexts such as goals and daily stressors. Consequently, age may not affect emotional complexity in settings where the influence of age-specific life contexts is reduced. However, this hypothesis has yet to be explored. In the present study, we investigated one aspect of emotional complexity, namely emotion differentiation. Extending previous research, we assessed age-group differences in negative emotion differentiation between young and older adults in a controlled experimental setting. A sample of 114 young and 132 older adults rated their emotional response to 34 negative pictures according to intensity of four negative emotions. Based on these ratings, two indicators of emotion differentiation were calculated. The results revealed no significant age-group differences in negative emotion differentiation. The findings indicate stability in negative emotion differentiation with increasing age when the influence of life context is reduced. The findings are consistent with life span theories suggesting that developmental changes in emotional complexity occur largely as a result of age-related changes in life contexts rather than more stable age-related changes in individual characteristics.

Mediators of Change in a Parent Training Program for Early ADHD Difficulties: The Role of Parental Strategies, Parental Self-Efficacy, and Therapeutic Alliance.

Objective: The aim was to explore mediators of change in parent training (PT) for 3- to 8-year-old children with ADHD difficulties. Method: Parents of 64 children received PT with Incredible Years® and assessed child ADHD symptoms and conduct problems and their parenting strategies, parental self-efficacy, and therapeutic alliance before, during, and after PT. Product-of-coefficients mediation analyses in multilevel models were applied, and causal relations between mediators and outcome were investigated in time-lagged analyses. Results: Increased parental self-efficacy and reduced negative parenting statistically mediated reductions in ADHD and conduct problems in the product-of-coefficient analyses. However, time-lagged analyses were unable to detect a causal relation between prior change in mediators and subsequent child symptom reduction. There was limited evidence of therapeutic alliance as mediator of child symptom reduction or change in parenting variables. Conclusion: Parental self-efficacy and reductions in negative parenting may mediate change in PT, but more fine-grained time-lagged analyses are needed to establish causality.

Emotional reactivity and interoceptive sensitivity: Exploring the role of age.

Interoceptive sensitivity (IS) refers to the ability to accurately perceive visceral afferent information, and several prominent theories of emotions suggest that IS is associated with heightened emotional reactivity. Recent evidence has pointed to a decline in IS with age, but there is no consistent evidence of age-related decline in emotional reactivity. This may be because the relationship between IS and emotional reactivity changes with age. To address this hypothesis, we examined the moderating role of age in the association between IS and emotional responses to affect-inducing images. A sample of 65 young adults (mean age = 23.91 years, SD = 4.62) and 32 older adults (mean age = 61.78 years, SD = 8.76) was exposed to affect-inducing images from the Nencki Affective Picture System database and completed a heartbeat perception task. Participants' subjective emotional responses to the images were assessed with questionnaires, and their physiological reactivity was indicated by electrodermal activity, heart rate, and heart rate variability during image viewing. The results revealed that age moderated the association between IS and emotional reactivity, while no significant age differences were found in IS, change in affect, or physiological reactivity. The findings demonstrated that IS was associated with emotional reactivity for young adults but not for older adults, suggesting that young and older adults may differ in their use of internal bodily signals to obtain information about their emotional experience. Consistent with contemporary developments within the affective sciences, the results emphasize the importance of individual differences in emotional experiences.

Age-dependent Reactivity to Affective Images: Evidence for Variation Across Emotion Categories.

BACKGROUND: Research on the effect of age on affective reactivity continues to provide inconsistent findings. The present study addresses two potential explanations that may account for these inconsistencies. First, gender may moderate age differences in affective reactivity and second, age differences in affective reactivity may vary according to emotion category. The aim of the present study was therefore to examine age differences in reactions to emotion-inducing images when singling out the effect of gender and emotion category. METHODS: A sample of 396 young (mean age = 23.31, SD = 3.70; 66% female) and old (mean age = 66.09, SD = 4.31; 37.5% female) Danish adults rated 105 images from the Nencki Affective Picture System (NAPS) database according to valence and arousal. Images were divided into the three emotion categories of disgust, sadness, and happiness. RESULTS: The findings indicate that age-group influenced affective reactivity, but there was no indication of an an interaction between age-group and gender. Going beyond previous studies, the findings demonstrate that the effect of age-group on affective reactivity varies according to emotion category. CONCLUSION: The results highlight the importance of considering emotion category in studies of age differences in affective reactivity.

A randomized controlled trial of emotion regulation therapy for generalized anxiety disorder with and without co-occurring depression.

OBJECTIVE: Generalized anxiety disorder (GAD) and major depression (MDD), especially when they co-occur, are associated with suboptimal treatment response. One common feature of these disorders is negative self-referential processing (NSRP; i.e., worry, rumination), which worsens treatment outcome. Emotion Regulation Therapy (ERT) integrates principles from affect science with traditional and contemporary cognitive-behavioral treatments to identify and modify the functional nature of NSRP by targeting motivational and regulatory mechanisms, as well as behavioral consequences. METHOD: Building on encouraging open trial findings, 53 patients with a primary diagnosis of GAD (43% with comorbid MDD) were randomly assigned to immediate treatment with ERT (n = 28) or a modified attention control condition (MAC, n = 25). RESULTS: ERT patients, as compared with MAC patients, evidenced statistically and clinically meaningful improvement on clinical indicators of GAD and MDD, worry, rumination, comorbid disorder severity, functional impairment, quality of life, as well as hypothesized mechanisms reflecting mindful attentional, metacognitive, and overall emotion regulation, which all demonstrated mediation of primary outcomes. This superiority of ERT exceeded medium effect sizes with most outcomes surpassing conventions for a large effect. Treatment effects were maintained for nine months following the end of acute treatment. Overall, ERT resulted in high rates of high endstate functioning for both GAD and MDD that were maintained into the follow-up period. CONCLUSIONS: Findings provide encouraging support for the efficacy and hypothesized mechanisms underlying ERT and point to fruitful directions for improving our understanding and treatment of complex clinical conditions such as GAD with co-occurring MDD. (PsycINFO Database Record

Changes in perceived centrality of anxious events following cognitive behavioral therapy for social anxiety disorder and panic disorder.

BACKGROUND AND OBJECTIVE: The purpose of the present study was to explore the association between reductions in symptoms of psychopathology and perceived centrality of negative autobiographical memories in participants with social anxiety disorder (SAD) or panic disorder (PD). METHODS: Thirty-nine individuals with SAD or PD recalled and rated four negative autobiographical memories before and after ten sessions of cognitive behavioral therapy (CBT) over a three-month period. Twenty-eight healthy controls did the same before and after a three-month period. RESULTS: As hypothesized, results showed a decrease in perceived centrality following CBT. This decrease in perceived centrality was larger, although at the trend level, for individuals who experienced reliable change on disorder-specific symptoms. LIMITATIONS: The correlational nature of the study prevents establishing the causal relationship between changes in perceived centrality and psychopathology, and future studies should explore such mechanisms. CONCLUSIONS: The present study adds to the emerging body of literature, investigating changes in centrality of event following psychotherapy.

The effect of expressive writing intervention for infertile couples: a randomized controlled trial.

STUDY QUESTION: Is expressive writing intervention (EWI) efficacious in reducing distress and improving pregnancy rates for couples going through ART treatment? SUMMARY ANSWER: Compared to controls, EWI statistically significantly reduced depressive symptoms but not anxiety and infertility-related distress. WHAT IS KNOWN ALREADY: ART treatment is considered stressful. So far, various psychological interventions have been tested for their potential in reducing infertility-related distress and the results are generally positive. It remains unclear whether EWI, a brief and potentially cost-effective intervention, could be advantageous. STUDY DESIGN SIZE, DURATION: Between November 2010 and July 2012, a total of 295 participants (163 women, 132 men) were randomly allocated to EWI or a neutral writing control group. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were couples undergoing IVF/ICSI treatment. Single women and couples with Preimplantation Genetic Diagnosis or acute change of procedure from insemination to IVF, were excluded. EWI participants participated in three 20-min home-based writing exercises focusing on emotional disclosure in relation to infertility/fertility treatment (two sessions) and benefit finding (one session). Controls wrote non-emotionally in three 20-min sessions about their daily activities. The participants completed questionnaires at the beginning of treatment (t1), prior to the pregnancy test (t2), and 3 months later (t3). In total, 26.8% (79/295) were lost to follow-up. Mixed linear models were chosen to compare the two groups over time for psychological outcomes (depression, anxiety and infertility-related distress), and a Chi2 test was employed in order to examine group differences in pregnancy rates MAIN RESULTS AND THE ROLE OF CHANCE: One hundred and fifty-three participants received EWI (women = 83; men = 70) and 142 participants were allocated to the neutral writing control group (women = 83; men = 62). Both women and partners in the EWI group exhibited greater reductions in depressive symptoms compared with controls (P = 0.049; [CI 95%: -0.04; -0.01] Cohen's d = 0.27). The effect of EWI on anxiety did not reach statistical significance. Overall infertility-related distress increased marginally for the partners in the EWI group compared to the partners in the control group (P = 0.06; Cohen's d = 0.17). However, in relation to the personal subdomain, the increase was statistically significant (P = 0.01; Cohen's d = 0.24). EWI had no statistically significant effect on pregnancy rates with 42/83 (50.6%) achieving pregnancy in the EWI group compared with 40/80 (49.4%) in the control group (RR = 0.99 [CI 95% = 0.725, 1.341]; P = 0.94). LIMITATIONS, REASONS FOR CAUTION: The results for depressive symptoms corresponded to a small effect size and the remaining results failed to reach statistical significance. This could be due to sample characteristics leading to a possible floor-effect, as we did not exclude participants with low levels of emotional distress at baseline. Furthermore, men showed increased infertility-related distress over time. WIDER IMPLICATIONS OF THE FINDINGS: EWI is a potentially cost-effective and easy to implement home-based intervention, and even small effects may be relevant. When faced with infertility, EWI could thus be a relevant tool for alleviating depressive symptoms by allowing the expression of feelings about infertility that may be perceived as socially unacceptable. However, the implications do not seem to be applicable for men, who presented with increased infertility-related distress over time. STUDY FUNDING/COMPETING INTERESTS: The present study was supported by research grants from Merck Sharpe and Dohme and The Danish Agency for Science Technology and Innovation as part of a publicly funded PhD. The funding bodies had no influence on the data collection, analysis or conclusions of the study. None of the authors have any conflicts of interest to declare. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov, trial no. NCT01187095. TRIAL REGISTRATION DATE: 7th September 2010 DATE OF FIRST PATIENT'S ENROLMENT: 23rd November 2010.

Efficacy of Mindfulness-Based Cognitive Therapy on Late Post-Treatment Pain in Women Treated for Primary Breast Cancer: A Randomized Controlled Trial.

PURPOSE: To assess the efficacy of mindfulness-based cognitive therapy (MBCT) for late post-treatment pain in women treated for primary breast cancer. METHODS: A randomized wait list-controlled trial was conducted with 129 women treated for breast cancer reporting post-treatment pain (score ≥ 3 on pain intensity or pain burden assessed with 10-point numeric rating scales). Participants were randomly assigned to a manualized 8-week MBCT program or a wait-list control group. Pain was the primary outcome and was assessed with the Short Form McGill Pain Questionnaire 2 (SF-MPQ-2), the Present Pain Intensity subscale (the McGill Pain Questionnaire), and perceived pain intensity and pain burden (numeric rating scales). Secondary outcomes were quality of life (World Health Organization-5 Well-Being Index), psychological distress (the Hospital Depression and Anxiety Scale), and self-reported use of pain medication. All outcome measures were assessed at baseline, postintervention, and 3-month and 6-month follow-up. Treatment effects were evaluated with mixed linear models. RESULTS: Statistically significant time × group interactions were found for pain intensity (d = 0.61; P = .002), the Present Pain Intensity subscale (d = 0.26; P = .026), the SF-MPQ-2 neuropathic pain subscale (d = 0.24; P = .036), and SF-MPQ-2 total scores (d = 0.23; P = .036). Only pain intensity remained statistically significant after correction for multiple comparisons. Statistically significant effects were also observed for quality of life (d = 0.42; P = .028) and nonprescription pain medication use (d = 0.40; P = .038). None of the remaining outcomes reached statistical significance. CONCLUSION: MBCT showed a statistically significant, robust, and durable effect on pain intensity, indicating that MBCT may be an efficacious pain rehabilitation strategy for women treated for breast cancer. In addition, the effect on neuropathic pain, a pain type reported by women treated for breast cancer, further suggests the potential of MBCT but should be considered preliminary.

Negative autobiographical memories in social anxiety disorder: A comparison with panic disorder and healthy controls.

BACKGROUND AND OBJECTIVES: Empirical interest in mental imagery in social anxiety disorder (SAD) has grown over the past years but still little is known about the specificity to SAD. The present study therefore examines negative autobiographical memories in participants with social anxiety disorder (SAD), compared to patients with panic disorder (PD), and healthy controls (HCs). METHODS: A total of 107 participants retrieved four memories cued by verbal phrases associated with either social anxiety (SA) or panic anxiety (PA), with two memories for each cue category. RESULTS: PA-cued memories were experienced with stronger imagery and as more traumatic. They were also rated as more central to identity than SA-cued memories, but not among participants with SAD, who perceived SA-cued memories as equally central to their identity. When between-group effects were detected, participants with anxiety disorders differed from HCs, but not from each other. LIMITATIONS: Central limitations include reliance on self-report measures, comorbidity in the anxiety disorder groups, and lack of a neutrally cued memory comparison. CONCLUSIONS: The findings align with models of SAD suggesting that past negative social events play a central role in this disorder. Future research is suggested to further explore the function of negative memories, not only in SAD, but also in other anxiety disorders.

Neuropsychological test performance in social anxiety disorder.

BACKGROUND: The effect of state factors on neuropsychological performance in social anxiety disorder (SAD) has not been thoroughly investigated and the overall neuropsychological profile remains poorly understood. AIMS: The primary objective of the study was to investigate the effect of state anxiety and state emotion suppression on neuropsychological performance in SAD. METHODS: A neuropsychological test battery was administered before and after an anxiety manipulation (instruction to give a video-recorded speech) to 42 patients with SAD and to a gender and education matched group of 42 healthy controls (HCs). RESULTS: Overall, participants with SAD performed worse than HCs on processing speed, visuospatial construction, visuospatial memory, verbal learning and word fluency, of which only the decreased visuospatial construction performance was considered clinically significant. State anxiety was not associated with neuropsychological performance at baseline, whereas state emotion suppression predicted decreased visuospatial memory in HCs and decreased verbal learning in the SAD group. Both groups performed better on working memory, processing speed and spatial anticipation, and worse on verbal learning and memory following the anxiety manipulation. The increase in state anxiety was associated with the decrease in verbal learning in both groups. CONCLUSIONS: Participants with SAD showed clinically significant difficulties with visuospatial construction and may experience verbal learning difficulties when suppressing emotions and experiencing an increase in anxiety.