The Relationship Between Psychological Inflexibility and Well-Being in Adults: A Meta-Analysis of the Acceptance and Action Questionnaire.

Psychological inflexibility is defined as the rigid responding to stimuli (e.g., unpleasant thoughts and feelings) that interferes with well-being and valued actions. It is the treatment target in acceptance and commitment therapy (ACT). Despite the centrality of the link between inflexibility and well-being to ACT theory, an empirical review clarifying the nature of this relationship has not been conducted. As such, the current meta-analysis examined the meta-correlation between psychological inflexibility, measured by the Acceptance and Action Questionnaire (AAQ) and its variants, and well-being. A systematic review yielded 151 studies, including 25 versions of the AAQ and 43 well-being measures. Consistent with ACT theory, higher psychological inflexibility was associated with worse well-being (r = -.47, 95% CI[-.49, -.45]). In addition, sample diagnosis, type of AAQ, and type of well-being measure significantly moderated this relationship. Overall, our findings support the hypothesized link between psychological inflexibility and worse well-being. Limitations include reliance on cross-sectional data, precluding causal interpretation.

Impact of preference for yoga or cognitive behavioral therapy in patients with generalized anxiety disorder on treatment outcomes and engagement.

There is some, but inconsistent, evidence to suggest that matching patient treatment preference enhances treatment engagement and outcome. The current study examined differential preferences and factors associated with treatment preference for 12-week group cognitive behavioral therapy (CBT), yoga, or stress education in 226 adults with generalized anxiety disorder (GAD; 70% female, Mean age = 33 ± 13.5). In a subsample of 165 patients who reported an intervention preference and were randomized to yoga or CBT, we further examined whether match to preferred intervention improved the primary treatment outcome (responder status on Clinical Global Impressions Scale) and engagement (dropout, homework compliance). Preferences for CBT (44%) and yoga (40%) were similar among patients. Women tended to prefer yoga (OR = 2.75, p = .01) and CBT preference was associated with higher baseline perceived stress (OR = 0.92, p = .04) and self-consciousness meta-cognitions (OR = 0.90, p = .02). Among those not matched to their preference, treatment response was higher for those receiving CBT than yoga (OR = 11.73, p = .013); there were no group differences for those matched to their treatment preference. In yoga, those who received their preference were more likely to drop than those who did not (OR = 3.02, 95% CI = [1.20, 7.58], p = .037). This was not the case for CBT (OR = 0.37, 95% CI = [0.13, 1.03], p = .076). Preference match did not predict homework compliance. Overall, results suggest that treatment preference may be important to consider to optimize outcome and engagement; however, it may vary by treatment modality. Future research incorporating preference, especially with yoga for anxiety, is aligned with personalized medicine. TRIAL REGISTRATION: clinicaltrials.gov: NCT01912287; https://clinicaltrials.gov/ct2/show/NCT01912287.

Distinct and interacting impacts of trait anxiety and a state anxiety manipulation on attentional switching.

BACKGROUND AND OBJECTIVES: According to the Attentional Control Theory, individuals with high levels of anxiety often shift their attention inefficiently due to increased effort to meet task demands. However, literature on the effects of anxiety on shifting performance is discrepant. This study examined the impacts of trait and state anxiety on attentional shifting and whether worry or depression explained variance in shifting. DESIGN AND METHODS: One-hundred thirty-eight undergraduate psychology students were randomized to the Trier Social Stress Test (TSST) or control TSST. Subjects completed measures of state/trait anxiety, worry, and depression and a computerized attention task. Statistical analyses included linear mixed modelling (LMM), t-tests, and ANOVAs. RESULTS: Results revealed significant effects of state and trait anxiety and worry, but not depression. Type (location/direction) and presentation (switch/repeat) of trials also affected response times. Trait anxiety significantly related to trial presentation but did not interact with trial type. State anxiety did not significantly relate to either trial index. State and trait anxiety significantly impacted overall response time. Results revealed variations in cognitive flexibility, but no interactions between state and trait anxiety in predicting task switching. CONCLUSION: These findings are discussed in the context of Attentional Control Theory and relevant empirical research.

When two hearts beat as one: Heart-rate synchrony in social anxiety disorder.

Individuals with social anxiety disorder (SAD) experience significant interpersonal impairment. However, little is known about the physiological processes that are associated with interpersonal dysfunction in the disorder. In the present study we examined heart-rate (HR) synchrony in SAD during "getting-acquainted" interactions between opposite-sex partners. Participants included 118 individuals who formed 59 dyads: 30 dyads that included one individual with SAD and one non-socially anxious (NSA) individual (SAD dyads) and 29 dyads that included two NSA individuals (control dyads). Dyads were randomly assigned to either a closeness-generating conversation or a small talk conversation. For closeness-generating conversations, we found that social anxiety was positively associated with HR synchrony in control dyads but negatively associated with HR synchrony in SAD dyads. These results remained when controlling for depressive symptoms and participants' movement. Our findings suggest that in more intimate social contexts, SAD may impair the ability to create HR synchrony between interlocuters and this can have negative relational consequences. Our findings are further discussed in the context of cognitive behavioral and interpersonal models of SAD, and clinical and research implications are delineated.

Anhedonia is central for the association between quality of life, metacognition, sleep, and affective symptoms in generalized anxiety disorder: A complex network analysis.

BACKGROUND: Poor quality of life, sleep problems, anhedonia, and negative metacognitions are common in anxiety and depression. To examine the nature of the relationship between these features and the role of metacognitions, anhedonia, and quality of life in anxiety and depression, we conducted a complex network analysis with items of self-report measures assessing quality of life, sleep, negative thinking styles, anxiety, and depression. METHODS: Participants were 226 treatment seeking individuals with a primary DSM-5 diagnosis of generalized anxiety disorder. Node centrality, strength, expected influence, community, and bridge estimation were calculated using partial correlation coefficients and glasso regularization. RESULTS: Results revealed that anhedonia was the most central node followed by quality of life nodes. Moreover, anhedonia exhibited the highest strength and expected influence, which were both stable, reliable metrics within the network. Metacognitions were not central nodes in the network, but were strong bridge symptoms between communities. LIMITATIONS: The results are limited by the cross-sectional nature of the data and the administration of self-report scales at one time-point, despite different rating anchors. CONCLUSION: These findings suggest that anhedonia is a crucial element for the association between quality of life, sleep problems, and negative cognitions.

Emotion Regulation Flexibility in Generalized Anxiety Disorder.

BACKGROUND: People differ in their affective styles, which refers to habitual use of emotion regulation (ER) strategies. Previous research has shown that mental health is associated with an individual's adaptive flexibility of emotion regulation strategies rather than any one particular ER strategy. METHODS: The present study employed a person-centered approach using latent profile analyses to distinguish patients with generalized anxiety disorder based on their responses on an affective styles measure. RESULTS: Results of the latent profile analysis supported a three-class solution. Class 1 (26% of participants) identified individuals with the lowest scores of each affective style; class 2 (10%) included individuals with the highest scores of each style; and class 3 (64%) consisted of individuals who scored in the mid-range of each affective style. Greater ER flexibility was associated with better emotional functioning and quality of life. CONCLUSIONS: Patients with GAD differ in ER flexibility. The vast majority of patients appear to have only moderate or low ER flexibility. Those individuals with high ER flexibility show a greater quality of life and less emotional distress.

Comparing the efficacy of benzodiazepines and serotonergic anti-depressants for adults with generalized anxiety disorder: a meta-analytic review.

INTRODUCTION: Generalized anxiety disorder (GAD) is a common form of anxiety disorder. Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines (BZs) are the most commonly prescribed medications for GAD, but little is known about the relative efficacy of these pharmacological treatments. Areas covered: This study provides a meta-analytic review of the efficacy of these medications in the treatment of adults with GAD. A comprehensive literature search yielded 54 articles reporting 56 unique studies with 12,655 participants treated with either pill placebo (6,191 participants), SSRIs (16 trials, 2,712 participants), SNRIs (17 trials, 2,603 participants), or BZs (23 trials, 1,149 participants). The overall combined effect size was modest to moderate (Hedges' g = 0.37, p < 0.0001). Effect sizes decreased significantly over time. SSRIs (Hedges' g = 0.33) and SNRIs (Hedges' g = 0.36) demonstrated significantly lower effect sizes than BZs (Hedges' g = 0.50). These findings were not due to differences in treatment length or publication year. Expert opinion: The results of this study suggest that the most common forms of pharmacotherapy for adult GAD are moderately effective, with BZs being the most effective drug.