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Worry is a transdiagnostic symptom common to many neurocognitive disorders of aging, including early stages of Alzheimer's disease and related dementias (ADRD). Severe worry is associated with amyloid burden in cognitively intact older adults, yet the mechanisms underlying this association are not well understood. We hypothesize that this relationship involves altered brain and cardiovascular reactivity to acute stressors, a brain-body phenotype that also increases risk for cardiovascular disease. Twenty cognitively normal older adults (age 60 to 80) with varying levels of worry severity underwent positron emission tomography using Pittsburgh Compound-B and functional magnetic resonance imaging. We examined associations of worry severity and amyloid burden with cardiovascular reactivity, brain activation, and brain connectivity using a cognitive stressor task. Worry severity was not associated with global amyloid burden, but was associated with greater resting levels of cardiovascular physiology and lower systolic blood pressure reactivity. Worry severity also was associated with altered stressor-evoked activation and effective connectivity in brain circuits implicated in stress processing, emotion perception, and physiological regulation. These associations showed small to medium effect sizes. These preliminary findings introduce key components of a model that may link severe worry to ADRD risk via stressor-evoked brain-body interactions., Competing Interests: Declaration of competing interest All authors report no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background and Objectives: Transdiagnostic approaches have been promoted as a means of maximising preventative effects across multiple problems with depression and anxiety suitable targets as they appear to have highly interconnected systems in pathology development and maintenance. This study investigated long-term effects of two universal school-based programs, Emotion Regulation (ER) and Behavioral Activation (BA), that sought to prevent depression and anxiety by targeting worry (a transdiagnostic feature) to promote resilience., Methods: This follow-up study captured data from 162 of 316 initial students (aged 8-13; 52.2% female), from six Australian schools. The original study design cluster randomised students by school into BA, ER, or a usual class control. Intervention conditions consisted of 8 × 50-min weekly sessions. This study measured the effects of these interventions after 24 months on resilience, worry, depression, and anxiety. Resilience was also examined as a potential mediator., Results: At 24-month follow-up, there was no significant effect of either intervention on depression, anxiety, worry, or resilience levels. Significantly fewer participants in ER and BA met clinical thresholds for separation anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) in the 24-month follow-up compared with baseline. No mediation effects were found., Limitations: Although self-report measures are common in universal, school-based research, this represents a study limitation., Conclusions: Both interventions may provide limited long-term protective effects on SAD and OCD symptoms, which appear to have a shelf-life shorter than 24 months. To maintain program effects, refresher sessions at shorter intervals may be a consideration for future research., Competing Interests: Declaration of competing interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. No authors have any conflicts or competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: In a preregistered study, we examined whether worries about COVID-19 are simultaneously linked with enhanced well-being through social interaction and with reduced well-being through depression symptoms., Method: In August 2020, census-matched participants from high- and low-prevalence regions in the United States and Italy (N = 857) completed assessments of COVID-19 worry, social interaction, depression symptoms, and well-being., Results: Worries about COVID-19 predicted both more social interaction and more depression (ps < 0.001). In multiple mediational analyses, an adaptive pathway of COVID-19 worry through social interaction was associated with higher well-being, whereas a maladaptive pathway through depression symptoms was associated with lower well-being. Further, a comparison of high and low COVID-19 prevalence regions replicated the mediational findings for social interaction, providing evidence against reverse causation and common method variance., Conclusion: Findings suggest that normative worries about acute stressors may both benefit and undermine well-being, depending on their impact on social behavior or depression symptoms., (© 2024 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Pathological anxiety is highly prevalent, impairing, and often chronic. Yet, despite considerable research, mechanistic understanding of anxiety and its translation to clinical practice remain limited. Here, we first highlight two foundational complications that contribute to this gap: a reliance on a phenomenology-driven definition of pathological anxiety in neurobiological mechanistic research, and a limited understanding of the chronicity of anxiety symptom expression. We then posit that anxiety symptoms may reflect aberrant expression of otherwise normative defensive responses. Accordingly, we propose that threat imminence, an organizing dimension for normative defensive responses observed across species, may be applied to organize and understand anxiety symptoms along a temporal dimension of expression. Empirical evidence linking distinct anxiety symptoms and the aberrant expression of imminence-dependent defensive responses is reviewed, alongside the neural mechanisms which may underpin these cognitive, physiological, and behavioral responses. Drawing from extensive translational and clinical research, we suggest that understanding anxiety symptoms through this neurobiologically-informed framework may begin to overcome the conceptual complications hindering advancement in mechanistic research and clinical interventions for pathological anxiety., (© 2024. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

Background and Objectives: This study examined the association between COVID-19 concerns and depression among adults in later life. We also examined whether race/ethnic status moderated this relationship. Research Design and Methods: This study used data from the 2020 Health and Retirement Study. Using the 8-item CES-D scale, we defined probable depression as having three or more depressive symptoms. COVID-19 concerns included items such as concerns about respondents' own health, the health of family members, respondents' ability to get help from others, and concerns about the future. The associations between COVID-19 concerns and older adults' depression were estimated with logistic regression models. Results: Compared to respondents with lower scores on the COVID-19 concern measures, those with higher scores were more likely to be depressed. The moderation model showed the relationship between concerns about what will happen in the future and depression was not as strong among non-Hispanic Black older adults compared to non-Hispanic White older adults. Concerns about own health, family members' health, the older adult's financial situation, and the ability to get help did not show moderation effects. Discussion and Implications: The results suggested that healthcare providers should focus on older persons to reduce disparities in the risk of depression during public health emergencies., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To understand what Parkinson's Disease (PD) patients report in their own words about their mood and anxiety problems using the Parkinson's Disease Patient Report of Problems (PD-PROP)., Methods: Patient-reported data from the PD-PROP (reporting most bothersome problems due to PD in their own words), Geriatric Depression Scale, MDS-UPDRS II, and the Euro-Q0L from the Fox Insight research database (https://foxinsight.michaeljfox.org/) were examined using cross-sectional comparisons and logistic regression analyses to characterize non-depressive mood symptoms and anxiety., Results: We identified 21,487 participants who completed at least one PD-PROP questionnaire. Four categories of non-depressive mood symptoms (Anxiety/Worry, Loneliness/Isolation, Negative Emotions NOS (Not Otherwise Specified), Death/Suicidal Ideation) were identified. Women were much more likely than men to report non-depressive mood symptoms as a bothersome PD-related problem. The frequency of Anxiety/Worry reporting decreased with longer duration of PD while Loneliness/Isolation increased. More severe PD motor impairment, as measured by the MDS-UPDRS II, was associated with increased reporting of Negative Emotions and Loneliness/Isolation. Higher Euro-QoL, indicating better quality of life, was associated with decreased reporting of Loneliness/Isolation. Death/Suicidal Ideation was only reported by a small number of participants (<0.5 %)., Conclusions: Women were more likely than men with PD to identify Anxiety/Worry, Negative Emotions, and Loneliness/Isolation as problems. This finding and the higher prevalence of bothersome loneliness/isolation as PD duration increases can guide monitoring for these issues., Competing Interests: Declaration of competing interest Our declaration of financial interest is as follows-all authors received payment as honoraria for their work on this project from grant funding obtained by Connie Marras, MD, from Michael J. Fox Foundation. We have no other financial interests relevant to this project to report. Please direct any questions or concerns to me, as the corresponding author., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Using the self-regulatory executive function model as a basis, this study explored whether, among substance users, metacognitive beliefs and repetitive negative thinking were associated with impulsiveness., Methods: A total of 100 substance users were recruited. Impulsiveness, metacognitive beliefs, rumination and worry were assessed. Correlation and hierarchal regression analyses were run., Results: Beliefs about the need to control thoughts, lower cognitive self-consciousness and brooding rumination were found to be independent predictors of the total score on impulsiveness in the hierarchical regression analysis. Further regression analyses indicated that motor impulsiveness was predicted by a combination of beliefs about the need to control thoughts and brooding rumination, while non-planning impulsiveness was predicted by beliefs about the need to control thoughts and lower cognitive self-consciousness., Conclusion: Among substance users, higher impulsiveness is associated with the tendency to endorse beliefs about the need to control thoughts and brooding rumination. Among substance users, beliefs about the need to control thoughts and brooding rumination (and potentially cognitive self-consciousness) could be a suitable therapeutic targets to mitigate particularly motor impulsiveness and non-planning impulsiveness., (© 2024 John Wiley & Sons Ltd.)

Suicidal ideation (SI), a risk factor for suicide, is prevalent in internalizing psychopathologies, including depression and anxiety. Rumination and worry are well-studied repetitive negative thinking (RNT) constructs implicated in internalizing psychopathologies. These constructs have shared and distinct characteristics. However, the relationship between rumination and worry and their associations with SI are not fully understood in clinical samples. The present study used correlational and regression analysis to evaluate these relationships as a secondary data analysis in treatment-seeking participants with internalizing psychopathologies in two independent samples (Study 1:n = 143; Study 2:n = 133). Results showed about half of the participants endorsed SI (Study 1:n = 79; Study 2:n = 71). Correlations revealed a significant, positive relationship between rumination and worry. Regression results with SI as the dependent variable showed rumination significantly positively corresponded with SI in both studies. Post-hoc partial correlations controlling for symptom severity (depression, anxiety), worry, and age showed the rumination-SI relationship was maintained in both studies. Findings for worry and SI were inconsistent between studies. Findings indicate rumination, but not worry, could be a stable, unique contributor to SI in internalizing psychopathologies. It may be useful to incorporate RNT into suicide risk assessment for individuals with internalizing conditions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

People high in depressive or anxious symptom severity show repetitive negative thinking, including worry and rumination. They also show various cognitive phenomena, including probability, cost, and interpretation biases. Since there is conceptual overlap between these cognitive biases and repetitive negative thinking - all involve thinking about potential threats and misfortunes - we wondered whether repetitive negative thinking could account for (mediate) these cognitive biases' associations with depressive and anxious symptom severity. In three studies, conducted in two languages and cultures, cost bias and (in two studies) interpretation bias only predicted symptom severity via worry and repetitive negative thinking; this suggests these biases are actually associated with repetitive negative thinking, rather than with symptoms. In contrast, probability bias showed direct relationships with depressive (all studies) and anxious (two studies) symptom severity, suggesting its relationships with symptoms are partly independent of repetitive negative thinking. These results show the value of studying relationships among the various cognitive features of psychopathology. Furthermore, new interventions which target cognitive biases in depression or anxiety must show that they can improve upon cognitive behavioural therapy, which is already widely available, targets both repetitive negative thinking and probability bias, and is highly effective.

Background: Research on the nature and prevalence of phenomena like climate anxiety (or eco-anxiety) is increasing rapidly but there is little understanding of the conditions under which climate change worry becomes more or less likely to significantly impact mental wellbeing. Here, we considered two plausible moderators of the relationship between climate change worry and mental wellbeing: neuroticism and efficacy beliefs., Methods: Analysis was conducted with survey data gathered in six European countries in autumn 2019. Participants were recruited from universities in the participating countries using opportunity sampling., Results: We found that climate change worry is negatively related to mental wellbeing at any level of perceived efficacy. In contrast, climate change worry is only significantly related to mental wellbeing at low and average levels of neuroticism. High neuroticism appears to have a masking, rather than amplifying, role in the relationship between climate change worry and mental wellbeing., Limitations: The cross-sectional design of the study precludes verification of causal relationships among variables. The brief measure of neuroticism employed also did not allow for nuanced analysis of how different facets of neuroticism contribute to the observed interaction with climate change worry. Findings cannot be indiscriminately generalised to less privileged groups facing the worst impacts of the climate crisis., Conclusion: Our findings lend to a view that harmful impacts of climate change worry on mental wellbeing cannot simply be ascribed to dispositional traits like neuroticism. We advocate for interventions that tackle negative climate-related emotions as unique psychological stressors., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: Past research has been inconclusive regarding the specificity of associations between discrete pleasurable emotions and internalizing symptoms. Contentment may be especially relevant to depression, whereas tranquillity may be especially relevant to worry. The goal of the current research was to clarify the mixed findings regarding the relation between pleasure deficits and internalizing psychopathology., Methods: Participants from three samples (Total N = 757) completed alternative measures of depression and pleasurable emotions. Participants in Study 1 also completed a measure of anticipatory and consummatory pleasure, and close peers to a subset of participants (N = 64) reported their perceptions of participants' depression severity. Participants in Studies 2 and 3 also completed a measure of worry., Results: Across the three samples, contentment was significantly negatively associated with self-reported depression. This association could not be accounted for by tranquillity, cheerfulness, anticipatory pleasure, or consummatory pleasure. Contentment was also strongly negatively associated with peer-reported depression. Contentment was more strongly associated with depression than was cheerfulness. However, the strength of the association between contentment and depression relative to the strength of the association between tranquillity and depression depended on how contentment and depression were measured. Conversely, tranquillity was more strongly associated with worry than were contentment or cheerfulness., Conclusions: This study provides further evidence of the potential importance of the role of contentment in depression and tranquillity in worry. It may be useful to attend to contentment when assessing and treating depression and to attend to tranquillity when assessing and treating elevated worry., (© 2024 The Author(s). British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: Worry is frequently associated with reduced cognitive performance, through consumption of attention control resources. Assessing attention control during acute worry may better reflect cognitive performance in real-world scenarios. This study examined whether attention control (assessed at rest and under acute worry) moderates the relationship between worry and academic performance., Methods: Worry (Penn State Worry Questionnaire) and academic performance (examination grades) were assessed in 87 undergraduates, with attention control (antisaccade performance) measured at baseline and following worry induction., Results: When assessed at rest, attention control did not moderate the relationship between trait worry and academic performance. However, under acute worry, attention control significantly moderated the relationship between worry and academic performance ( p  = .05, f = 0.14), such that at low levels of attention control under worry, higher trait worry was significantly associated with lower academic performance. At high levels of attention control under worry, however, the relationship between trait worry and academic performance was not significant.2  = 0.14), such that at low levels of attention control under worry, higher trait worry was significantly associated with lower academic performance. At high levels of attention control under worry, however, the relationship between trait worry and academic performance was not significant., Conclusions: Findings suggest that worry may shape performance according to attention control levels, with attention control's moderating role being more pronounced under conditions of acute worry. These results provide preliminary evidence that attention control assessed under worry may better predict real-world performance, compared to assessment at rest.

Background/objectives: Autistic adults exhibit core and comorbid features that can have an impact on their daily functioning and lead to considerable psychological distress. Significant and consistent associations have been identified between autism characteristics-restricted repetitive behaviors and sensory features-and high levels of stress and anxiety. For a better understanding of the issue, it is necessary to consider the cognitive aspects that can help explain variations in stress and anxiety levels among adults with autism. We therefore aimed to model the contributions of worry and intolerance of uncertainty on the relationship between autism characteristics (sensory sensitivities and repetitive behaviors) and psychological distress (stress and anxiety)., Methods: The sample comprised 144 autistic individuals with a mean age of 35.15 (SD = 11.44). They participated in the study by completing an online questionnaire to assess the study variables. Most of the participants reported being diagnosed with Asperger syndrome (63.6%) or Level 1 autism spectrum disorder (27.1%)., Results: The model fit index values tested through path analysis indicated a good fit (χ 2 = 5.65; p = 0.13 ns; CFI = 0.993; NFI = 0.985; RMSEA = 0.079; SRMR = 0.025) and identified worry and intolerance of uncertainty as significant mediating variables within a comprehensive explanatory model., Conclusions: These findings highlight the importance of worry and intolerance of uncertainty as specific targets in interventions aimed at improving stress and anxiety problems in autistic adults.

Background: Theory and research indicated that executive functioning (EF) correlated with, preceded, and stemmed from worry in generalized anxiety disorder (GAD). The present secondary analysis (Zainal & Newman, 2023b) thus determined whether EF domains mediated the effect of a 14-day (5 prompts/day) mindfulness ecological momentary intervention (MEMI) against a self-monitoring control (SM) for GAD., Method: Participants ( N = 110) diagnosed with GAD completed self-reported (Attentional Control Scale, GAD Questionnaire, Perseverative Cognitions Questionnaire) and performance-based tests (Letter-Number Sequencing, Stroop, Trail Making Test-B, Verbal Fluency) at baseline, post-treatment, and one-month follow-up (1MFU). Causal mediation analyses determined if pre-post changes in EF domains preceded and mediated the effect of MEMI against SM on pre-1MFU changes in GAD severity and trait repetitive negative thinking (RNT)., Results: MEMI was more efficacious than SM in improving pre-post inhibition ( β = -2.075, 95% [-3.388, -0.762], p = .002), working memory ( β = 0.512, 95% [0.012, 1.011], p = .045), and set-shifting ( β = -2.916, 95% [-5.142, -0.691], p = .010) but not verbal fluency and attentional control. Within groups, MEMI but not SM produced improvements in all examined pre-post EF outcomes except attentional control. Only pre-post improvements in inhibition mediated the effect of MEMI against SM on pre-1MFU reductions in GAD severity ( β = -0.605, 95% [-1.357, -0.044], p = .030; proportion mediated = 7.1%) and trait RNT ( β = -0.024, 95% [-0.054, -0.001], p = .040; proportion mediated = 7.4%). These patterns remained after conducting sensitivity analyses with non-linear mediator-outcome relations., Conclusions: Optimizing MEMI for GAD might entail specifically boosting inhibition plausibly by augmenting it with dialectical behavioral therapy, encouraging high-intensity physical exercises, and targeting negative emotional contrast avoidance.

Background: Using the metacognitive model of emotion dysregulation as a basis, this study explored whether, among participants with substance use disorders (SUDs), metacognitive beliefs and repetitive negative thinking were associated with emotion dysregulation., Methods: 127 participants with SUDs and 127 controls without SUDs were recruited. Emotion dysregulation, metacognitive beliefs, rumination, worry, anxiety, and depression were assessed. t-tests, Mann-Whitney tests, logistic regression, correlation, and hierarchal regression analyses were run., Results: Participants with SUDs reported significantly higher levels of emotion dysregulation, positive beliefs about worry, beliefs about the need to control thoughts, rumination, and worry, compared to controls without SUDs. Among participants with SUDs negative beliefs about thoughts concerning uncontrollability and danger, cognitive confidence, beliefs about the need to control thoughts, rumination, and worry were significantly associated with an increase of emotion dysregulation., Limitations: The cross-sectional design., Conclusion: Emotion dysregulation, metacognitive beliefs, and repetitive negative thinking may contribute to increase the risk of substance use. Among participants with SUDs emotion dysregulation is associated with the tendency to endorse dysfunctional metacognitive beliefs and report repetitive negative thinking. Metacognitive beliefs and repetitive negative thinking could be a suitable therapeutic target to reduce emotion dysregulation among participants with SUDs., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Context: Little is known about how patients' emotions impact the choice between hemi- and total thyroidectomy (TT) for low-risk thyroid cancer (LR-TC) and how these emotions change after treatment., Objective: To investigate thyroid cancer-specific fear and worry both before and after treatment of LR-TC with hemi- or TT., Methods: This prospective cohort study enrolled adults with confirmed or likely LR-TC at 15 institutions. Participants completed measures of thyroid cancer-related fear and worry at the time of their treatment decision and 9-months later. Participants were categorized as having low, medium, or high levels of fear and worry in accordance with the literature. Those choosing hemi-thyroidectomy were compared to those choosing TT., Results: Of 177eligible patients, 125 (70.6%) enrolled and 114 completed both surveys (91.2% retention). Overall, 41 (36.0%) participants chose hemi-thyroidectomy and 73 (64.0%) chose TT. Across all participants, thyroid cancer-related fear and worry both decreased significantly after surgery (fear 25.8±6.4 to 23.1±7.4; worry 8.2±2.4 to 5.4±2.1, p<0.001). The proportion of participants with high fear decreased from 64.9% to 50.9%, while the proportion with high worry decreased from 75.4% to 41.2% (p<0.001 for both). At both time points, no differences existed between those choosing hemi- and TT in levels of worry or fear., Conclusion: Patients with LR-TC report lower levels of fear and worry 9-months after surgery regardless of the extent of surgery, suggesting that both surgeries provide an emotional benefit to some patients. Thyroid cancer-related fear and worry do not appear to influence patients' decisions to undergo hemi- or TT., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms.)

Background: Around the world, people living in objectively difficult circumstances who experience symptoms of generalized anxiety disorder (GAD) do not qualify for a diagnosis because their worry is not 'excessive' relative to the context. We carried out the first large-scale, cross-national study to explore the implications of removing this excessiveness requirement., Methods: Data come from the World Health Organization World Mental Health Survey Initiative. A total of 133 614 adults from 12 surveys in Low- or Middle-Income Countries (LMICs) and 16 surveys in High-Income Countries (HICs) were assessed with the Composite International Diagnostic Interview. Non-excessive worriers meeting all other DSM-5 criteria for GAD were compared to respondents meeting all criteria for GAD, and to respondents without GAD, on clinically-relevant correlates., Results: Removing the excessiveness requirement increases the global lifetime prevalence of GAD from 2.6% to 4.0%, with larger increases in LMICs than HICs. Non-excessive and excessive GAD cases worry about many of the same things, although non-excessive cases worry more about health/welfare of loved ones, and less about personal or non-specific concerns, than excessive cases. Non-excessive cases closely resemble excessive cases in socio-demographic characteristics, family history of GAD, and risk of temporally secondary comorbidity and suicidality. Although non-excessive cases are less severe on average, they report impairment comparable to excessive cases and often seek treatment for GAD symptoms., Conclusions: Individuals with non-excessive worry who meet all other DSM-5 criteria for GAD are clinically significant cases. Eliminating the excessiveness requirement would lead to a more defensible GAD diagnosis.

Objective: The study ascertained the effects of Black college women's experiences of gendered racism on worry. Psychosocial resources were examined as factors expected to reduce the impact of gendered racial microaggressions on worry. Participants: The sample comprised 197 Black-identified students enrolled at a southern Historically Black College or University. Methods: A cross-sectional research design was used. After adjusting for covariates, Ordinary Least Squares (OLS) regression models evaluated the associations between gendered racial microaggressions, psychosocial resources, and worry. Results: Frequent experiences of gendered racial microaggressions were associated with heightened worry. The Angry Black Woman stereotype had the most robust relationship with worry. Psychosocial resources, specifically mastery, self-esteem, and resilience, reduced the impact of gendered racial microaggressions on worry. Conclusion: Gendered racism contributes to increased worry, and thus, heightens the risk of experiencing anxiety. High levels of mastery, self-esteem, and resilience reduce the effects of gendered racism on worry.

Background: Tackling poor mental health in university students has been identified as a priority in higher education. However, there are few evidence-based prevention initiatives designed for students. Repetitive Negative Thought (RNT, e.g. worry, rumination) is elevated in university students and is a well-established vulnerability factor for anxiety and depression. Furthermore, there are now evidence-based cognitive-behavioural interventions to tackle RNT. A mobile self-help cognitive-behavioural app targeting RNT, adapted for students may therefore be an effective, scalable, and acceptable way to improve prevention in students., Methods: An online single blind, two-arm parallel-group Randomised Controlled Trial (RCT) to examine the incidence of major depression and symptoms of anxiety and depression across 12 months in university students aged over 16 who screen into the study with self-reported high levels of worry and/or rumination and no current diagnosis of major depression. Eligible participants will be randomised to the active intervention arm (usual practice plus using a self-guided mobile app targeting RNT) or to the control arm (usual practice). In total, 648 participants aged over 16, with no current major depression, bipolar disorder or psychosis will be recruited from UK universities. Assessments will take place at baseline (pre-randomisation), 3 months and 12 months post- randomisation. Primary endpoint and outcome is incidence of major depression as determined by self-reported diagnostic criteria at 12-month follow-up. Depressive symptoms, anxiety, well-being, health-related quality of life, functioning and academic outcomes are secondary outcomes. Compliance, adverse events, and potentially mediating variables will be carefully monitored., Discussion: The trial aims to provide a better understanding of the causal role of tackling RNT (worry, rumination) using a self-help mobile app with respect to preventing depression in university students. This knowledge will be used to develop and disseminate innovative evidence-based, feasible, and effective mobile-health public health strategies for preventing common mental health problems., Trial Registration: https://www.isrctn.com/ISRCTN86795807 Date of registration: 27 October 2022., (© 2024. The Author(s).)

Generalized anxiety disorder is characterized by disruptions in decision-making, including an enhanced aversion to uncertain outcomes (i.e., risk aversion), which is not specific to negative outcomes (i.e., no loss aversion). It is unknown if this uncertainty bias is a trait-like causal factor contributing to anxiety symptoms, or a state-like feature triggered by anxiety symptoms such as worry chains. Here, in-patients with Major Depression Disorder (MDD), with (N = 16) or without (N = 24) Generalized anxiety (GA) symptoms, and healthy controls (N = 23), completed an economic decision-making task before and after worry induction. They were asked to choose between a certain monetary payoff, and an uncertain gamble, allowing for estimation of risk and loss aversion through a computational prospect-theoretic model. There were no significant differences in risk and loss aversion between any of the three groups at baseline. After worry induction, patients with GA symptoms, compared to those without, showed increased risk aversion. This increase was modulated by the severity of anxiety symptoms. These findings suggest that decision-making disruptions in anxiety disorder may be driven by anxiety symptoms such as worry, rather than causing them. This could shape etiological models, motivate standardization of emotional state in research on decision-making in anxiety disorders, support treatment strategies primarily aimed at worry management, and could guide novel interventions focusing on uncertainty exposure across aversive and appetitive domains., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: Epidemiological studies revealed an unestablished association between neuroticism and posttraumatic stress disorder (PTSD) and we conducted mendelian randomization (MR) analyses to examine whether neuroticism clusters of worry, depressed affect, and sensitivity to environmental stress and adversity (SESA) were involved in the development of PTSD., Method: We obtained data on three neuroticism clusters, PTSD, and nine other psychiatric disorders from genome-wide association studies summary statistics and employed univariable, multivariable, and mediation MR analyses to explore causal associations among them., Results: Neuroticism clusters were linked with PTSD (depressed affect (odds ratio [OR]: 2.94 [95% confidence interval: 2.21-3.92]); SESA (2.69 [1.95-3.71]; worry (1.81 [1.37-2.99])). Neuroticism clusters were also associated with psychiatric disorders, with the depressed effect on panic disorder (PD) (2.60 [1.14-5.91]), SESA on anorexia nervosa (AN) (2.77 [1.95-3.94]) and schizophrenia (2.55 [1.99-3.25]), worry on major depressive disorder (MDD) (2.58 [2.19-3.05]). In multivariable MR, only the SESA-PTSD association remained (2.60 [2.096, 3.107]) while worry-PTSD and depressed affect-PTSD associations attenuated to nonsignificance. Mediation MR analyses suggested that PD mediated 3.76% of the effect of depressed effect on PTSD and AN mediated 10.33% of the effect of SESA on PTSD., Conclusion: Delving deeper into neuroticism clusters, we comprehensively understand the role of neuroticism in PTSD., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Objectives: Anal incontinence (AI) is a distressing condition with grave impact on many aspects of life, including quality of life (QoL), social life and sexual activities. This study explored how AI and bowel symptoms impact QoL in a Norwegian population by (1) describing the psychosocial and sexual consequences of AI, and (2) investigating factors most often associated with AI-specific QoL., Materials and Methods: A cross-sectional study among patients with AI referred to hospital outpatient clinics was conducted. A Norwegian version of ICIQ-B was used to measure bowel control, bowel symptoms, sexual impact, and impact on QoL., Results: A total of 208 persons with AI completed the questionnaire. The results demonstrated that these patients are overall embarrassed, make plans according to the bowels, ensure the presence of a nearby toilet, and many abstain from sexual activities. After adjusting for other variables included in a multivariable model, we found that having bowel accidents on one's mind had the greatest relative impact on QoL, followed by lower bowel control, using more medications to stop bowels, having more pain/soreness around the back passage, lower age, and more straining to open the bowels., Conclusions: AI has substantial consequences for the psychosocial function and sexual activities of persons with AI. This study indicates that worrying about potential faecal accidents and the social stigma associated with this have greater impact on QoL than actual bowel leakages. Future studies should therefore focus on the emotional burden, patient coping, and health education related to bowel function and AI.

Objective: Anxiety disorders and subsyndromal anxiety symptoms are highly prevalent in late life. Recent studies support that anxiety may be a neuropsychiatric symptom during preclinical Alzheimer's disease (AD) and that higher anxiety is associated with more rapid cognitive decline and progression to cognitive impairment. However, the associations of specific anxiety symptoms with AD pathologies and with co-occurring subjective and objective cognitive changes have not yet been established., Methods: Baseline data from the A4 and Longitudinal Evaluation of Amyloid Risk and Neurodegeneration studies were analyzed. Older adult participants (n = 4,486) underwent assessments of anxiety (State-Trait Anxiety Inventory-6 item version [STAI]), and cerebral amyloid-beta (Aβ; 18 F-florbetapir) PET and a subset underwent tau ( 18 F-flortaucipir) PET. Linear regressions estimated associations of Aβ in a cortical composite and tau in the amygdala, entorhinal, and inferior temporal regions with STAI-Total and individual STAI item scores. Models adjusted for age, sex, education, marital status, depression, Apolipoprotein ε4 genotype, and subjective and objective cognition (Cognitive Function Index-participant; Preclinical Alzheimer Cognitive Composite)., Results: Greater Aβ deposition was significantly associated with higher STAI-Worry, adjusting for all covariates, but not with other STAI items or STAI-Total scores. In mediation analyses, the association of Aβ with STAI-Worry was partially mediated by subjective cognition with a stronger direct effect. No associations were found for regional tau deposition with STAI-Total or STAI-Worry score., Conclusion: Greater worry was associated with Aβ but not tau deposition, independent of subjective and objective cognition in cognitively unimpaired (CU) older adults. These findings implicate worry as an early, specific behavioral marker and a possible therapeutic target in preclinical AD., (Copyright © 2024 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Schizophrenia is a severe psychiatric disorder, associated with a reduction in life expectancy of 15-20 years. Available treatments are at least partially effective in most affected individuals, and personal resources such as resilience (successful adaptation despite adversity) and coping abilities (strategies used to deal with stressful or threatening situations), are important determinants of disease outcomes and long-term sustained recovery. Published findings support the existence of a genetic background underlying resilience and coping, with variable heritability estimates. However, genome-wide analyses concerning the genetic determinants of these personal resources, especially in the context of schizophrenia, are lacking. Here, we performed a genome-wide association study coupled with accessory analyses to investigate potential genetic determinants of resilience, coping and self-esteem in 490 schizophrenia patients. Results revealed a complex genetic background partly overlapping with that of neuroticism, worry and schizophrenia itself and support the importance of social aspects in shapingthese psychological constructs. Hippocampal neurogenesis and lipid metabolism appear to be potentially relevant biological underpinnings, and specific miRNAs such as miR-124 and miR-137 may warrant further studies as potential biomarkers. In conclusion, this study represents an important first step in the identification of genetic and biological correlates shaping resilience, coping resources and self-esteem in schizophrenia., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Objective., Job strain has been implicated in a variety of adverse health outcomes, particularly cardiometabolic and inflammatory diseases. However, the mechanisms underlying these effects remain largely unknown. One possibility is that the maladaptive coping response to stress, (perseverative cognition (PC); the cognitive representation of past stressful events (rumination) or feared future events (worry)), either in work or more generally, mediates the relationship between job strain and physical disease. The aim of this study was thus to test the potential role of both general, and work- related PC as a mediating, or potentially moderating, mechanism between job strain and ill- health outcomes., Design & Measures., Using an online cross- sectional design, 650 full- time employees completed measures of job strain, general and work- related PC (rumination & worry) and health outcomes (burnout, somatization, health behaviours & sleep quality)., Results., General and work- related worry and rumination significantly mediated, often independently, the relationship between job strain and burnout, somatization, and sleep quality. No significant mediation effects were observed for health behaviours and no type of PC (general or work- related) moderated job strain- health outcome relations., Conclusion., Both general and work- related worry and rumination are likely to play important, and partly independent, roles in understanding the adverse relationships between job strain and various health outcomes.

Protocol Registration: PROSPERO (CRD42023408899).

Worry and rumination are two forms of repetitive negative thoughts. Prior studies have identified similarities and differences between these two states. For a more comprehensive understanding of these thought processes, researchers need reliable methods to induce them experimentally. Traditionally, researchers have used either scripted or personalized approaches to trigger worry and rumination, but it remains unclear which method is more effective. Additionally, the potential impact of preexisting disorders like generalized anxiety disorder (GAD) or major depression (MDD) on these inductions is not well understood. This study aimed to compare scripted and personalized induction methods to identify which was more effective for eliciting worry and rumination, while also considering the potential influence of generalized anxiety and depression. Participants ( N = 355) included individuals with GAD, depression, or healthy controls. They were randomly assigned to either scripted or personalized induction tasks designed to induce worry or rumination. Findings revealed that personalized induction methods were consistently more effective than scripted methods for inducing both worry and rumination, regardless of participants' group characteristics. In addition to the general underperformance of scripted induction methods, the scripted rumination induction was notably less successful, failing to induce rumination to a greater extent than the scripted worry induction. Given these findings, personalized approaches are recommended for experimental studies that aim to compare worry and rumination. Limitations of the study and implications for future research are also discussed., Competing Interests: Declaration of interest The authors declare no conflict of interest. Additional Declarations: The authors declare no competing interests.

Background: Thought processes such as worries are often described as difficult to control and predict suicidal thoughts and behaviors (STBs). Due to their uncontrollable nature, worries may lead to STBs as people attempt to escape their own internal thought processes., Objective: Examine the indirect role of perceived uncontrollability of one's thoughts in the relationship between worry and STBs., Design and Method: We used stepwise mediation models to examine the proposed relationship in a sample of 145 undergraduates with lifetime suicidal ideation. STBs were categorized into (1) severity of lifetime suicidal ideation, (2) likelihood and (3) severity of recent suicidal ideation, and (4) lifetime suicide attempt. The likelihood and severity of recent ideation were separated due to the skewed nature of suicidal thoughts, with many people reporting zero ideation., Results: Worry was related to the severity of lifetime ideation, the likelihood of reporting recent ideation, and the severity of recent ideation through lower levels of perceived ability to control one's thoughts. Worry was not related to a lifetime suicide attempt., Conclusion: The perception that one's thoughts are uncontrollable may be a core feature of worry for the development and worsening of suicidal thinking. Interventions targeting internal perceptions of uncontrollability may be beneficial for suicidal ideation management.

Repetitive thinking is a common phenomenon, also implicated in a variety of mental disorders. The content of repetitive thoughts can take the form of prediction of aversive events (in worry) or evoking negatively valenced information (in rumination), for instance. Investigating the influence of repetitive thinking through the lens of associative learning could help deepen our understanding of the mechanisms involved in its effects.In two experiments, non-clinical participants were exposed to CS-US pairings with the aim of creating non-threatening expectancy learning (Experiment 1) or evaluative conditioning (Experiment 2). After each conditioning trial, participants were instructed to initiate repetitive thoughts about the pairing (i.e. rehearse) or follow control instructions.Experiment 1 (N = 64) showed that such intervention strengthen the association between the mental representations of the CS and the US, leading to a stronger US expectancy in response to the CS. In Experiment 2 (N = 107), an evaluative conditioning effect was observed; however, it was not influenced by instructions.The study demonstrated that simulated repetitive thinking strengthens the CS-US association and leads to greater US expectancy in expectancy learning, despite appearing not to influence the evaluative conditioning effect. The potential implications of these findings on repetitive thinking are discussed.

Objective: This study aimed to unravel micro-processes that link information seeking to subsequent affective well-being (i.e., positive and negative affect) at the within-person level, as well as the role of worry as a mediator in this relationship., Methods and Measures: Within the initial weeks following the Chinese government's relaxation of its epidemic control measures, 184 participants completed experience sampling methods on information seeking, COVID-related worry, and affective well-being three times a day for 14 days., Results: According to dynamic structural equation models, information seeking was associated with high negative affect but not with low positive affect. COVID-related worry acted as a full mediator between information seeking at the previous time point (approximately 5 h ago) and the current negative affect, but not in positive affect., Conclusion: These findings suggested that the impact of information seeking on affective well-being was different for the two dimensions of affect. Furthermore, the persistent impact of information seeking on negative affect was attributed to the indirect effect of worry, suggesting that worry should be a point of focus for intervention to mitigate the potentially negative effects of information seeking within the context of the public health crises.

Background: People who were disabled from working reported substantially worse depression in recent research [1] despite adjustment for demographic covariates, cognitive-appraisal processes, and COVID-specific stressors, thus motivating the present work., Objective: This study sought to "drill down" to understand employment-group differences (employed, retired, unemployed, disabled) in cognitive factors, and how these factors played into paths to depression during COVID early in the pandemic and depression trajectories over 15.5 months of follow-up., Methods: This longitudinal cohort study (n = 771) included chronically ill and general-population samples in the United States, characterized into the same depression-trajectory groups as the earlier study [1]. The Quality-of-Life Appraisal Profile v2 Short-Form assessed cognitive-appraisal processes. COVID-specific scales assessed hardship, worry, and social support. Chi-square, Analysis of Variance, classification and regression tree, and random effects modeling investigated factors associated with reported depression over time specifically by employment group, rather than in the whole sample which was the focus of the earlier study., Results: Disabled participants were disproportionately represented in the stably depressed trajectory group, reporting more hardship and worry, and lower social support than employed and retired participants (p < 0.0001). They were more likely to focus on health goals, problem goals, and emphasizing the negative (p < 0.001). They had different paths and cut-points to depression than employed/unemployed/retired participants. Even mild endorsement of emphasizing the negative and recent changes predicted higher depression. COVID-specific stressors and cognitive-appraisal processes were less implicated in depression among disabled participants compared to others., Conclusions: Disabled participants were at greater risk of stable depression during the COVID pandemic. Small increases in emphasizing the negative were a path to worse depression, and disabled participants' depression may be less reactive to external circumstances or ways of thinking., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Evidence on the optimal follow-up schedule after endometrial cancer is lacking. The study aim was to compare satisfaction with care between women who received reduced follow-up care and women who received usual guideline-directed follow-up care for three years after surgery., Methods: The ENSURE (ENdometrial cancer SURvivors' follow-up carE) trial was a non-inferiority randomized controlled multicenter trial in 42 hospitals in the Netherlands. The intervention arm received reduced follow-up care (4 visits/3 years), while the control group received usual follow-up care (8-11 visits/3 years). Primary outcome was overall satisfaction with care, PSQIII score, over three years follow-up, with a non-inferiority margin of 6. Mixed linear regression, intention-to-treat and per-protocol analyses (presented below) were used., Results: Among 316 women included, overall satisfaction with care was not lower in the reduced follow-up (mean 82; SD = 15) compared with the usual follow-up group (mean 80; SD = 15) group (B = 1.80(-2.09;5.68)). At 6, 12 and 36 months, more women (93/94/90%) in the reduced follow-up group were satisfied with their follow-up schedule than in the usual follow-up group (79/79/82%; p < 0.001; p < 0.001; p = 0.050)., Conclusions and Relevance: Women with low-risk, early-stage endometrial cancer who received reduced follow-up care were no less satisfied with their care than women receiving usual follow-up care. Compared with usual follow-up, women in the reduced follow-up group had fewer clinical visits and, at the same time, more often reported being satisfied with their follow-up schedule. Findings suggest that reduced follow-up care may be the new standard, but should be tailored to meet additional needs where indicated., Competing Interests: Declaration of competing interest Authors have no conflict of interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: This study examined whether high frequency heart-rate variability (HF-HRV) and HF-HRV reactivity to worry moderate response to cognitive behavioural therapy for insomnia (CBT-I) within both a standard and stepped-care framework among cancer patients with comorbid insomnia. Biomarkers such as HF-HRV may predict response to CBT-I, a finding which could potentially inform patient allocation to different treatment intensities within a stepped-care framework., Methods: 177 participants (86.3 % female; M age  = 55.3, SD = 10.4) were randomized to receive either stepped-care or standard CBT-I. 145 participants had their HRV assessed at pre-treatment during a rest and worry period. Insomnia symptoms were assessed using the Insomnia Severity Index (ISI) and daily sleep diary across five timepoints from pre-treatment to a 12-month post-treatment follow-up., Results: Resting HF-HRV was significantly associated with pre-treatment sleep efficiency and sleep onset latency but not ISI score. However, resting HF-HRV did not predict overall changes in insomnia across treatment and follow-up. Similarly, resting HF-HRV did not differentially predict changes in sleep diary parameters across standard or stepped-care groups. HRV reactivity was not related to any of the assessed outcome measures in both cross-sectional and longitudinal analyses., Conclusion: Although resting HF-HRV was related to initial daily sleep parameters, HF-HRV measures did not significantly predict longitudinal responses to CBT-I. These findings suggest that HF-HRV does not predict treatment responsiveness to CBT-I interventions of different intensity in cancer patients., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Josee Savard reports financial support was provided by Astellas. Thien Thanh Dang-Vu reports financial support was provided by Eisai,Idorsia,Jazz Pharmaceuticals, andPaladin Labs. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Fear and anxiety are rarely confined to specific stimuli or situations. In fear generalisation, there is a spread of fear responses elicited by physically dissimilar generalisation stimuli (GS) along a continuum between danger and safety. The current study investigated fear generalisation with a novel online task using COVID-19-relevant stimuli (i.e., busy or quiet shopping street/mall scenes) during pandemic lockdown restrictions in the United Kingdom. Participants (N = 50) first completed clinically relevant trait measures before commencing a habituation phase, where two conditioned stimuli (CSs; i.e., a busy or quiet high street/mall scene) were presented. Participants then underwent fear conditioning where one conditioned stimulus (CS+) was followed by an aversive unconditioned stimulus (US; a loud female scream accompanied by a facial photograph of a female displaying a fearful emotion) and another (CS-) was not. In a test phase, six generalisation stimuli were presented where the US was withheld, and participants provided threat expectancy and fear ratings for all stimuli. Following successful conditioning, fear generalization was observed for both threat expectancy and fear ratings. Trait worry partially predicted generalised threat expectancy and COVID-19 fear strongly predicted generalised fear. In conclusion, a generalisation gradient was evident using an online remote generalisation task with images of busy/quiet streets during the pandemic. Worry and fear of COVID-19 predicted fear generalisation., (© 2024. The Author(s).)

Purpose: To explore the intensity and variation of workers' worries, pain, psychosocial factors, and margin of manoeuvre before and after a return-to-work program, and identified the psychosocial factors associated with non-return to work at the end of the rehabilitation program., Methods: A pre-post study design was used. A convenience sample of 80 workers starting a return-to-work program and having a compensated musculoskeletal injury that caused an absence of more than three months from their regular work was recruited. Data were collected at baseline and at the end of the rehabilitation program on the nature of the worries and maintenance factors defined in Dugas' generalized anxiety and worry model, using validated questionnaires. The margin of manoeuvre was assessed by the treating occupational therapist. A series of descriptive analyses were performed, as well as Generalized Estimating Equations analyses., Results: Workers' worries were work-related or disability-related 83% of the time at baseline. These worries were essentially based on the situation then occurring at work 90% of the time. For the Generalized Estimating Equations analyses on work status, the final model was significant, explaining 54% of the variance in non-return to work (Pseudo R 2 = 0.54; p = 0.0001). Workers were 8.52 times less likely to return to work when the margin of manoeuvre was insufficient, and twice as likely not to return to work in the presence of intense worry. Worries were significantly associated with insufficient margin of manoeuvre., Conclusion: A strong association between workers' lack of margin of manoeuvre at work and their worries about their return to work, and poor work outcomes, supports the importance of the worker-environment interaction in rehabilitation programs., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Studies have confirmed that anxiety, especially worry and rumination, are associated with increased risk for cognitive decline, including Alzheimer's disease and related dementias (ADRD). Hippocampal atrophy is a hallmark of ADRD. We investigated the association between hippocampus and its subfield volumes and late-life global anxiety, worry, and rumination, and emotion regulation strategies. We recruited 110 participants with varying worry severity who underwent magnetic resonance imaging and clinical interviews. We conducted cross-sectional regression analysis between each subfield and anxiety, worry, rumination, reappraisal, and suppression while adjusting for age, sex, race, education, cumulative illness burden, stress, neuroticism, and intracranial volume. We imputed missing data and corrected for multiple comparisons across regions. Greater worry was associated with smaller subiculum volume, whereas greater use of reappraisal was associated with larger subiculum and CA1 volume. Greater worry may be detrimental to the hippocampus and to subfields involved in early ADRD pathology. Use of reappraisal appears protective of hippocampal structure. Worry and reappraisal may be modifiable targets for ADRD prevention., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Interpersonal problems are common in individuals with generalized anxiety disorder (GAD) and improved interpersonal functioning is an important goal in treatment. In the metacognitive model of worry and generalized anxiety disorder, emotional distress and psychological dysfunction are related to two distinct types of worry. Particular emphasis is put on meta-worry which refers to "worry about worrying" or appraisal of worrying as threatening in itself. Meta-worry impairs effective mental regulation and might therefore be an important predisposition to self-regulate via others and thereof interpersonal problems. In the current study, we tested the prediction that meta-worry is uniquely associated with interpersonal problems in two samples. The first consisted of 135 individuals with analogue GAD and the second of 56 individuals with a diagnosis of GAD. Using hierarchical linear regressions controlling for anxiety, depression and worry, meta-worry showed a unique relationship with interpersonal problems in both samples. These findings indicate that meta-worry may be relevant to formulate and treat interpersonal problems in individuals with GAD.

Background: This study aims to investigate the causal relationship between erectile dysfunction (ED) and psychological states including worry, tension, insomnia, sensitivity to environmental stress and adversity (SESA)., Method: This study the used two-sample bi-directional Mendelian randomization (MR) method. The study data was obtained from a pooled dataset of genome-wide association studies (GWAS). The bi-directional MR analysis was performed using inverse variance weighting, weighted median method, and MR-Egger regression analysis to assess the causality between ED and psychological states including worry, tension, insomnia, SESA in terms of odd ratios (OR). The study tested for heterogeneity using the Cochran Q method and for multiple validity using the MR-Egger and MR-PRESSO methods., Results: In forward MR analysis correlating worry, tension, insomnia, and SESA as exposures, no causal relationship was found between worry or tension and ED (p < 0.05). However, insomnia (p = 0.001, OR = 3.441, 95%CI = 1.593-7.435) and SESA (p = 0.004, OR = 1.804, 95%CI = 1.203-2.701) were found to have a significant causal effect on ED risk. The reverse MR analysis with ED as the exposure did not show any significant correlation (all p > 0.05)., Conclusion: Individuals with insomnia and SESA are at higher risk for developing ED. Clinical evaluation should be more thorough for these individuals. Insomnia can be treated simultaneously with psychological counseling to reduce the risk of ED. In addition, there is no evidence to suggest that worry and tension increase the risk of ED., (© 2023 The Authors. Andrology published by Wiley Periodicals LLC on behalf of American Society of Andrology and European Academy of Andrology.)

Background: Generalized anxiety disorder (GAD)-characterised by excessive and uncontrollable worry-is the most frequently diagnosed anxiety disorder during pregnancy and the postpartum period. Identification of GAD often relies on assessment of its cardinal feature, pathological worry. The Penn State Worry Questionnaire (PSWQ) is the most robust measure of pathological worry to date but has not been extensively evaluated for use during pregnancy and the postpartum period. This study evaluated the internal consistency, construct validity, and diagnostic accuracy of the PSWQ in a sample of pregnant and postpartum women with and without a principal GAD diagnosis., Methods: One hundred forty-two pregnant and 209 postpartum women participated in this study. Sixty-nine pregnant and 129 postpartum participants met criteria for a principal diagnosis of GAD., Results: The PSWQ demonstrated good internal consistency and converged with measures assessing similar constructs. Pregnant participants with principal GAD scored significantly higher on the PSWQ than those with no psychopathology and postpartum participants with principal GAD scored significantly higher than those with principal mood disorders, other anxiety and related disorders, and no psychopathology. A cut-off score of 55 and 61 or greater was determined for detecting probable GAD during pregnancy and the postpartum period, respectively. Screening accuracy of the PSWQ was also demonstrated., Conclusions: This study underscores the robustness of the PSWQ as a measure of pathological worry and probable GAD and supports its use in the detection and monitoring of clinically significant worry symptoms during pregnancy and postpartum period.

Objectives: This study aims to investigate the links between the clinical, demographic, and psychosocial factors and cancer-related worry in patients with early-stage lung cancer after surgery., Methods: The study utilized a descriptive cross-sectional design. Questionnaires, including assessments of cancer-related worry, symptom burden, illness perception, psychological resilience, coping modes, social support and participant characteristics, were distributed to 302 individuals in early-stage lung cancer patients after surgery. The data collection period spanned from January and October 2023. Analytical procedures encompassed descriptive statistics, independent Wilcoxon Rank Sum test, Kruskal-Wallis- H- test, Spearman correlation analysis, and hierarchical multiple regression., Results: After surgery, 89.07% had cancer-related worries, with a median (interquartile range, IQR) CRW score of 380.00 (130.00, 720.00). The most frequently cited concern was the cancer itself (80.46%), while sexual issues were the least worrisome (44.37%). Regression analyses controlling for demographic variables showed that higher levels of cancer-related worry (CRW) were associated with increased symptom burden, illness perceptions, and acceptance-rejection coping modes, whereas they had lower levels of psychological resilience, social support and confrontation coping modes, and were more willing to obtain information about the disease from the Internet or applications. Among these factors, the greatest explanatory power in the regression was observed for symptom burden, illness perceptions, social support, and sources of illness information (from the Internet or applications), which collectively explained 52.00% of the variance., Conclusions: Healthcare providers should be aware that worry is a common issue for early stage lung cancer survivors with a favorable prognosis. During post-operative recovery, physicians should identify patient concerns and address unmet needs to improve patients' emotional state and quality of life through psychological support and disease education., (© 2024. The Author(s).)

Background & Objectives: Worry and loss-related secondary stressors appear to be important correlates of problematic grief responses. However, the relative importance of these variables in the context of established correlates of grief responding, ranging from indicators of identity disruption and demographic characteristics of the bereaved to characteristics of the loss of quality of the relationship with the deceased, is unknown. Modeling the relative associations of these factors can be problematic, given the high degree of collinearity between these variables. This study used a machine learning approach to provide accurate estimations of the relative importance of these correlates for post-loss symptom severity., Methods and Results: A convenience sample of 428 bereaved people who had lost a parent, spouse, or child in the last 30 to 365 days completed an online survey. Random forest regression modeling examined the effects of worry and secondary stressors on symptom severity in the context of established correlates. Results indicated worry and the number of secondary stressors experienced were among the factors most strongly associated with severity of grief, depression, posttraumatic stress and problems functioning., Conclusions: These results also provide insight into the relative importance of worry and secondary stressors affecting grief severity to guide future research.

There is emerging interest in understanding positive affect dysfunction in relation to anxiety, including worry. This set of two studies examined the association between the inhibition of affect expression (general affect expressivity in Study 1, positive affect expressivity in Study 2) and worry, with a particular interest in the moderating role of proneness to experience positive affect. Subjects were US-residing adults (Study 1 N = 502, Study 2 N = 250) who were recruited through a crowdsourcing website and completed self-report measures of study variables. Moderated regression was used to examine study predictions that affect expression would negatively correlate with worry when coupled with diminished positive affect. Proneness toward negative affect was included as a covariate within multivariate analyses. An interactive effect between affect expressivity and positive affect was supported in Study 2 (positive affect expressivity) but not Study 1 (general affect expressivity) in relation to worry. A diminished tendency to express positive affect was associated with greater worry when coupled with less positive affect. Study results and future directions are discussed in terms of the potential emotion-regulatory functions of positive affect expressivity as it relates to worry., (© 2024 Springer Publishing Company.)

Background: Delivery of preventative interventions via mobile phone apps offers an effective and accessible way to address the global priority of improving the mental health of adolescents and young adults. A proven risk factor for anxiety and depression is elevated worry and rumination, also known as repetitive negative thinking (RNT)., Objective: This was a prevention mechanism trial that aimed to investigate whether an RNT-targeting self-help mobile phone app (MyMoodCoach) reduces worry and rumination in young adults residing in the United Kingdom. A secondary objective was to test whether the app reduces symptoms of anxiety and depression and improves well-being., Methods: A web-based, single-blind, 2-arm parallel-group randomized controlled trial was conducted with 236 people aged between 16 and 24 years, who self-reported high levels of worry or rumination. Eligible participants were randomized to an active intervention group (usual practice, plus up to 6 weeks of using the RNT-targeting mobile app, n=119) or a waitlist control group (usual practice with no access to the app until after 6 weeks, n=117). The primary outcome was changes in worry and rumination 6 weeks after randomization. Secondary outcomes included changes in well-being and symptoms of anxiety and depression after 6 weeks and changes in all measures after 12 weeks., Results: Participants randomly allocated to use the RNT-targeting self-help app showed significantly lower levels of rumination (mean difference -2.92, 95% CI -5.57 to -0.28; P=.03; η p =0.02) and worry (mean difference -3.97, 95% CI -6.21 to -1.73; P<.001; η 2 =0.02) and worry (mean difference -3.97, 95% CI -6.21 to -1.73; P<.001; η p 2 =0.06) at 6-week follow-up, relative to the waitlist control. Similar differences were observed for well-being (P<.001), anxiety (P=.03), and depression (P=.04). The waitlist control group also showed improvement when given access to the app after 6 weeks. Improvements observed in the intervention group after 6 weeks of using the app were maintained at the 12-week follow-up point., Conclusions: The MyMoodCoach app had a significant positive effect on worry and rumination, well-being, anxiety, and depression in young adults, relative to waitlist controls, providing proof-of-principle that an unguided self-help app can effectively reduce RNT. This app, therefore, has potential for the prevention of anxiety and depression although longer-term effects on incidence need to be directly evaluated., Trial Registration: ClinicalTrials.gov NCT04950257; https://www.clinicaltrials.gov/ct2/show/NCT04950257., International Registered Report Identifier (irrid): RR2-10.1186/s12888-021-03536-0., (©Daniel Edge, Edward Watkins, Alexandra Newbold, Thomas Ehring, Mads Frost, Tabea Rosenkranz. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 13.08.2024.)

Worry proneness is a transdiagnostic trait that predicts increased negative affect (NA), potentially in the service of preventing negative emotional contrasts. Although discrete types of NA vary along the dimension of arousal, the extent to which trait worry predicts high vs. low arousal forms of NA in daily life is unclear. This distinction has important implications for conceptualising how worry may perturb adaptive emotionality in various disorders. The present study (not pre-registered) aimed to isolate the effects of trait worry on high ( N  = 88) and low ( N  = 122) arousal NA in daily life using ecological momentary assessment while controlling for potential physical and psychological confounds. Participants were assessed for trait worry and depressive symptoms at baseline then reported their affect, heart rate, and exercise three times per day for one week. Multilevel models revealed that trait worry predicted both increased high and low arousal NA after controlling for momentary heart rate, daily exercise, and depression. In contrast, baseline depressive symptoms only predicted low arousal NA in daily life. Findings support the contrast avoidance model of worry and suggest that worry is linked to increased state NA in daily life, independent of arousal.

Generalized Anxiety Disorder (GAD) presents a significant personal and societal burden and is associated with chronic medical comorbidities and markedly lower quality of life. Effective treatments exist, less than half of individuals with lifetime GAD will ever seek psychotherapeutic or pharmacological treatment. A thorough understanding of the factors that influence treatment seeking for GAD is warranted. The present study investigates the correlates of GAD treatment seeking, using data from the National Epidemiological Survey on Alcohol and Related Disorders-III (NESARC-III), which assessed for psychiatric disorders using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version (AUDADIS-5). A series of logistic regressions were run to identify demographic, diagnostic, and symptom-level correlates of treatment seeking in those meeting DSM-5 diagnostic criteria for GAD. Comorbid depression, panic disorder, and PTSD were all uniquely associated with higher rates of GAD-related treatment seeking. Additionally, several accompanying anxiety symptoms were also uniquely predicted treatment seeking, including fatigue, panic attacks, reassurance-seeking, and interpersonal avoidance. Findings underscore the multi-factorial nature of treatment seeking behavior in GAD and highlight the need for further research to fully understand these relationships and devise effective strategies to improve treatment seeking in this population., Competing Interests: Declaration of Competing Interest JZ, TP, and JC have no conflicts of interest to report., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Anxiety disorders represent a prevalent mental health concern, with escalating rates, especially among emerging adults. University students, in particular, face a myriad of academic and life stressors that can amplify feelings of worry and anxiety. While early parental bonding seem to predict anxiety disorders later in life, the applicability to emerging adult students and its applicability to predict sub-clinical and transdiagnostic anxiety features remain unclear. This study aims to examine i) the relationship between demographic variables and key features of anxiety disorders (i.e., worry and anxiety symptoms); and ii) the predictive association between early parental bonding and anxiety-related features. A sample of 370 university students in Italy (n = 279 females; M age = 20.84 years, SD age = 1.81 years) completed the Parental Bonding Instrument, the Penn State Worry Questionnaire, and the Beck Anxiety Inventory. Females reported higher levels of worry and anxiety compared to males. Significantly higher worry and anxiety symptoms were reported by individuals who experienced affectionless control (low care and high overprotection) as compared to those exposed to optimal parenting (high care and low overprotection). Predictive models indicated that scores of parental care (i.e., the principal component between maternal and paternal care scores) and parental overprotection (i.e., the principal component between maternal and paternal overprotection scores) are robust predictors of worry and anxiety symptoms. However, this relationship showed a gender-specific pattern: lower parental care was more significant in predicting anxiety features in males, while high overprotection was more significant in females. The findings contribute to the comprehension of the risk factors influencing the susceptibility of emerging adult students to anxiety disorders., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Video recordings of oncology interviews reveal how doctors rely on worry to establish medical expertise, facilitate treatment decision-making, and construct worry parameters to help patients understand whether there is a reasonable need for worry or not. Doctors express worry as frequently as cancer patients during oncology interviews, but they face a dilemma: how to provide care for cancer patients without directly stating they are worried about them? Plausible explanations are offered for why doctors do not state personal worries. Conversation analytic methods were employed to identify how doctors rely on worry to achieve distinct social actions. Four worry formulations are examined: (1) variations of "we worry" (and at times, non-specific and second person "you"), (2) hypothetical worry scenarios, (3) dismissing worry and offering assurance, and (4) doctors claiming they are not worried, bothered, or alarmed. Doctors align with and speak for the professionals and institutions they represent, expressing collective worries and claiming the legitimate right to worry (or not). Doctors also avoid abandoning patients to their own decision-making, yet do not formulate worry to coerce deference or dictate patients' choices. In all cases patients agreed and displayed minimal resistance to doctors' worry formulations. These findings contribute to ongoing work across institutional settings where participants have been shown to construct objective, legitimate claims meriting worries about diverse problems. Work is underway to examine when and how patients explicitly raise and doctors respond to cancer worries. Clinical implications are raised for how doctors can use worry to legitimize best treatment options, help patients minimize their worries, rely on hypothetical scenarios allowing patients to compare how other patients managed their cancer, and not dismiss the importance of minimizing the need to worry as a resource for offering reassurance., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background and aims Problematic Social Network Sites Use (PSNSU) mirrors substance use disorders with regard to symptoms (e.g., diminished control). Recent theoretical advances in the addiction research field recognize a central role of affective and cognitive processes in the development of addictive behaviors. For example, the metacognitive model of addictive behaviors sustains that cognitive processes like extended thinking, disruption in metacognitive monitoring, and thought suppression are associated with addictive behaviors leading to increased craving. The current study aims to test the mediating role of extended thinking (i.e., worry, rumination, and desire thinking) in the relationship between psychological distress and PSNSU. Methods A community sample of 548 individuals (F = 68.5%, M age 29.29 ± 12.04 years) completed an online survey. Structural Equation Modeling (SEM) was utilized to analyze the relationships among the variables under study. Results The assessed structural model adequately fits the data, accounting for 89% of PSNSU variance. Psychological distress predicted PSNSU through the mediation of desire thinking and rumination and the serial mediation of (i) worry and craving (ii) desire thinking and craving The model is gender invariant. Conclusions The current findings provide preliminary evidence for the role of extended thinking in PSNSU. Worry, rumination and desire thinking may be central cognitive processes in eliciting craving and PSNSU for individuals who experience psychological distress.= 29.29 ± 12.04 years) completed an online survey. Structural Equation Modeling (SEM) was utilized to analyze the relationships among the variables under study. Results The assessed structural model adequately fits the data, accounting for 89% of PSNSU variance. Psychological distress predicted PSNSU through the mediation of desire thinking and rumination and the serial mediation of (i) worry and craving (ii) desire thinking and craving The model is gender invariant. Conclusions The current findings provide preliminary evidence for the role of extended thinking in PSNSU. Worry, rumination and desire thinking may be central cognitive processes in eliciting craving and PSNSU for individuals who experience psychological distress., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The primary objective was to assess the degree to which intolerance of uncertainty accounts for the association between negative urgency and anxiety and worry. The sample included 389 American college students from a state college in the Northeastern United States. Hayes' PROCESS v4.1 (2022) macro was used to investigate the mediating effects of intolerance of uncertainty on the relationship between negative urgency and worry and anxiety. A direct effect of negative urgency on worry was found and a mediating effect of intolerance of uncertainty was observed. A direct effect of negative urgency on state anxiety was found, and a mediating effect of intolerance of uncertainty was observed. The study advances support for the mediatory role of intolerance of uncertainty between negative urgency and anxiety and worry in American college students., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Insomnia symptoms are highly prevalent during pregnancy; therefore, identifying modifiable risk markers is important for risk prediction and early intervention. This study aimed to examine the role of sleep-specific rumination and sleep-specific worry in prenatal insomnia symptoms. A total of 859 married pregnant women without history of psychiatric illnesses (mean [standard deviation] age, 30.15 [3.86] years; 593 [69.0%] with a bachelor's degree or above) were enrolled from the obstetrical outpatient departments of two tertiary comprehensive hospitals in Shandong, China, who completed assessments of sleep-specific rumination, sleep-specific worry, and insomnia symptoms at baseline (mid-pregnancy) and follow-up (late-pregnancy). Measures included Daytime Insomnia Symptom Response Scale, Anxiety and Preoccupation about Sleep Questionnaire, and Insomnia Severity Index. Our results showed that after controlling for covariates, both sleep-specific rumination and sleep-specific worry showed significant concurrent and prospective associations with insomnia symptoms, and the increases in scores of sleep-specific rumination and sleep-specific worry over time were significantly associated with the increased likelihood of insomnia symptoms at follow-up. Moreover, the increases in sleep-specific rumination and sleep-specific worry over time were significantly associated with the increased likelihood of reporting newly developed insomnia symptoms rather than persistent normal sleep. However, the changes in sleep-specific rumination and sleep-specific worry were not significantly associated with the likelihood of reporting persistent or remitted insomnia symptoms rather than persistent normal sleep. In conclusion, sleep-specific rumination and sleep-specific worry were significantly associated with concurrent or subsequent insomnia symptoms; thus, they may be promising cognitive risk markers and intervention targets., (© 2024 European Sleep Research Society.)