Criticism and accommodation are associated with treatment concerns in close others to those with anxiety.

OBJECTIVES: Those close to people with mental health difficulties (e.g., family members, romantic partners and close friends) are often involved in their care decisions. Research shows that criticism by close others and accommodation of symptoms are associated with symptom severity and treatment response. Recent research has found that those close to someone with an anxiety disorder report a range of concerns about their loved one starting cognitive-behaviour therapy (e.g., that treatment will cause the person to change in undesirable ways). The purpose of this study was to examine the relationship between close others' criticism and symptom accommodation and their treatment concerns, hypothesizing that these relationships would be significant. DESIGN: Close others to those with notable anxiety (N = 287) completed self-report measures online. Multiple regression was used to test our hypothesis. METHODS: Respondents who identified as being close to someone with notable anxiety completed measures of their accommodation of anxiety symptoms, feelings of criticism/hostility towards them, concerns about them starting treatment, perceived impairment due to anxiety, and their own and their loved ones' treatment history. RESULTS: Greater criticism and accommodation significantly predicted greater treatment concerns, with a medium effect size, controlling for degree of impairment due to anxiety and treatment history. CONCLUSIONS: Criticism and accommodation may reflect appraisal of the person with anxiety as weak or fragile, which may evoke concerns about treatment success. Implications for clinicians and anxiety treatment are discussed.

Context matters: criticism and accommodation by close others associated with treatment attitudes in those with anxiety.

BACKGROUND: Many people with anxiety do not seek therapy due to negative views of treatment. Although close others (e.g. romantic partners, family members, close friends) are highly involved in treatment decisions, the role of specific relational behaviours in treatment ambivalence has yet to be studied. AIMS: This study examines the relationship between social predictors (perceived criticism and accommodation of anxiety symptoms by close others) and treatment ambivalence. METHOD: Community members who met diagnostic criteria for an anxiety-related disorder (N = 65) and students who showed high levels of anxiety (N = 307) completed an online study. They were asked to imagine they were considering starting cognitive behavioural therapy (CBT) for their anxiety and complete a measure of treatment ambivalence accordingly. They then completed measures of perceived criticism and accommodation by close others. Linear regression was used to examine the predictive value of these variables while controlling for sample type (clinical/analogue) and therapy experience. RESULTS: Greater reactivity to criticism from close others and greater accommodation of anxiety symptoms by close others were associated with greater treatment ambivalence in those with anxiety. These predictors remained significant even when controlling for therapy history and sample type. CONCLUSIONS: When it comes to treatment attitudes, relational context matters. Clients demonstrating ambivalence about starting therapy may benefit from discussion about the impact of their social environment on ambivalence.

Fear of compassion is associated with treatment ambivalence and negative expectations for treatment in people with anxiety.

OBJECTIVES: Fears of compassion are hypothesized to be associated with treatment attitudes, but this relationship has not yet been explored. METHODS: Measures of fear of compassion and treatment expectations and ambivalence were administered to those with above-average anxiety (N = 302) and those who met criteria for an anxiety or related disorder (N = 40). RESULTS: In those with anxiety disorders, fear of receiving compassion and fear of self-compassion were strongly correlated with treatment ambivalence. In both samples, higher fear of receiving compassion was associated with more negative expectations for treatment. CONCLUSIONS: Fear of compassion is associated with treatment ambivalence and treatment expectations and may be an important target early in treatment. PRACTITIONER POINTS: Fears of receiving compassion and self-compassion were related to treatment ambivalence and negative treatment expectations There may be benefit in targeting fear of compassion early in treatment.

Scared of compassion: Fear of compassion in anxiety, mood, and non-clinical groups.

OBJECTIVES: Fear of receiving compassion from others, expressing compassion to others, and being compassionate towards oneself have been identified as potentially important factors in the persistence of depression, stress disorders, and eating disorders. There is good reason to expect that these fears may play a role in anxiety and related difficulties, but there is little available information on the extent to which they are present and associated with symptom severity. METHODS: This study compared the severity of the three fears of compassion (receiving, expressing to others, and showing to oneself) in those with a principal diagnosis of depression (n = 34), obsessive-compulsive disorder (OCD; n = 27), social anxiety disorder (SAD; n = 91), generalized anxiety disorder (GAD, n = 43), and a control sample with no mental health difficulties (n = 212). RESULTS: Those with depression, OCD, SAD, and GAD exhibited greater fear of receiving compassion and fear of self-compassion than controls, and the differences between anxious and control groups remained significant even when controlling for depressed mood. Whereas fears of compassion did not predict symptom severity over and above depressed mood in people with GAD, fear of receiving compassion uniquely predicted SAD symptom severity, and fear of expressing compassion for others uniquely predicted OCD symptom severity in those high on fear of self-compassion. CONCLUSIONS: Fear of compassion is higher in those with anxiety and related disorders than non-anxious controls. Although further research is needed, clinicians may benefit from assessing fear of compassion and addressing it in treatment. PRACTITIONER POINTS: Those with anxiety and related disorders may fear receiving compassion from others or expressing compassion for themselves, even when controlling for depression. It may be informative to assess for fear of compassion and incorporate discussions about these fears into treatment, as these fears may interfere with treatment progress.

Hoarding: A meta-analysis of age of onset.

Hoarding disorder is present in 2-6% of the population and can have an immense impact on the lives of patients and their families. Before its inclusion the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, pathological hoarding was often characterized as a symptom of obsessive-compulsive disorder, and several different diagnostic assessment methods were used to identify and characterize it. Although the age of onset of pathological hoarding is an important epidemiological measure, as clarifying the age of onset of hoarding symptoms may allow for early identification and implementation of evidence-based treatments before symptoms become clinically significant, the typical age of onset of hoarding is still uncertain. To that end, this study is a systematic review and meta-analysis of research published in English between the years 1900 and 2016 containing information on age of onset of hoarding symptoms. Twenty-five studies met inclusion criteria. The mean age of onset of hoarding symptoms across studies was 16.7 years old, with evidence of a bimodal distribution of onset. The authors conclude by discussing practice implications for early identification and treatment.

How do close others to those with anxiety feel about treatment? Development and validation of the Treatment Concerns Questionnaire-Close Others.

Background: The close others (e.g., family members, romantic partners) of people with anxiety and related disorders are typically involved in their treatment decisions. However, we know little about close others' attitudes towards and concerns about their loved one starting cognitive-behavioural therapy (CBT). Methods: Study one surveyed close others of those with anxiety and related disorders (n = 33) about their concerns about their loved one starting CBT. Thematic coding was completed, and items were developed to reflect these themes, comprising a measure of treatment concerns in close others. Study two involved the administration of the novel measure to a larger sample (n = 287) to evaluate its structure, reliability, and validity. Results: Close others endorsed having treatment concerns of moderate intensity. The final 17-item measure, the Treatment Concerns Questionnaire-Close Others (TCQ-C), has a robust four-factor structure, with internally consistent subscales including "Adverse Reactions", "Personal/Family Consequences", "Lack of Commitment", and "Ineffectiveness". The measure shows moderate correlations with treatment expectations (convergent validity) and small correlations with respondent distress (discriminant validity). Conclusions: The value of this measure for clinicians and future directions for research are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s10608-022-10318-9.