Case histories and shorter communications

Worry: a potentially valuable concept

In this special series, new research on the Contrast Avoidance Model (CAM) was presented, including studies on the role of CAM in the maintenance of chronic worry, the incremental validity of CAM, CAM as a mediator of the association between generalized anxiety disorder (GAD) and other variables, CAM as transdiagnostic, and interpersonal behaviors as a means to avoid negative emotional contrasts (NECs). Furthermore, the role of perseverative thought in relation to positive emotional contrasts (PECs) was explored. Studies indicated that higher worry was positively and negatively reinforced, a factor that is likely to contribute to the maintenance of GAD. Further, research demonstrated that CAM contributed unique variance to understanding GAD above and beyond other variables associated with GAD, such as intolerance of uncertainty and negative problem orientation. Additional research revealed the transdiagnostic nature of contrast avoidance, as well as the association between contrast avoidance and problem-solving deficits. In addition, both worry and rumination increased the likelihood of PECs. Further, data suggested that anxious individuals may use interpersonal strategies to avoid NECs. Finally, savoring positive emotions was found to reduce contrast avoidance, providing a novel intervention strategy to address contrast avoidance in individuals with GAD.

Major disruptions to daily life routines made families and parents particularly vulnerable to psychological distress during the COVID-19 lockdowns. However, the specific psychopathological processes related to within-person variation and maintenance of anxiety symptomatology and parental distress components in the parental population have been largely unexplored in the literature. Methods: In this preregistered intensive longitudinal study, a multilevel dynamic network was used to model within-person interactions between anxiety symptomatology, psychopathological processes, parental distress, and protective lifestyle components in a sample of 495 parents—each responding to daily assessments over a 40-day period. A total of 30,195 observations were collected across the subjects.

Extensive worry, threat monitoring, and uncontrollability of worry were identified as overreaching psychopathological processes related to the aggravation of other symptoms of anxiety and parental distress. A strong association was found between parental stress and parental burnout. Anger toward one's child was associated with both parental stress and parental burnout. Protective factors showed the lowest strength centrality, with few and weak connections to other symptoms and processes in the network.

Associations may exist between the study variables on a different time scale; hence, different time lags should be used in future research. Conclusions: Accessible, low-cost interventions that address worry, threat monitoring, and the uncontrollability of worry could serve as potential targets for reducing the symptom burden of anxiety and distress in the parental population.

Les idées de persécutions constituent une problématique clinique de premier ordre car associées à un fonctionnement altéré, une moindre observance médicamenteuse et à des risques augmentés d’hospitalisations. Si le délire de persécution est principalement décrit dans les troubles du spectre schizophrénique, les données épidémiologiques en population générale et en populations cliniques mettent en évidence qu’elles se présentent davantage comme un continuum, dont l’expression délirante en représente l’extrémité. Dans cette revue nous nous sommes focalisés sur les avancées importantes apportées par les sciences psychologiques, et plus particulièrement les travaux de Daniel Freeman et Philippa Garety en Angleterre. Leurs travaux ont pu mettre en évidence qu’un ensemble de facteurs causaux participaient bien au-delà des modèles cognitifs et comportementaux classiques au développement et au maintien des idées délirantes. Des données probantes et désormais bien validées mettent les troubles du sommeil, la tendance à l’inquiétude, les biais de raisonnement, les expériences anormales, les croyances négatives sur soi, et les comportements de sécurité au centre du phénomène paranoïaque. Nous décrirons dans cette revue chacun de ses facteurs causaux en détail ainsi que les interventions cliniques développées par Freeman et ses collaborateurs, notamment l’intervention intégrative et modulaire « Feeling Safe ». Enfin, nous discuterons de manière critique les données d’efficacité des nombreuses études cliniques validant son efficacité. Les perspectives relatives à l’implémentation du programme Feeling Safe en France seront abordées.

Persecutory ideas are a major clinical problem and are associated with impaired functioning, reduced compliance with medication and increased risk of hospitalization. Persecutory ideation is defined as the false conviction that others are threatening or conspiring against one. Although persecutory delusions are mainly described and experienced in schizophrenia spectrum disorders, they also occur in other neurological and psychiatric diagnoses including Alzheimer disease, epilepsy, depression, mania, dementia and post-traumatic stress disorder. Moreover, epidemiological data from general and clinical populations indicated that paranoid beliefs occur on a hierarchy of severity and are present to a lesser degree in the general population, with paranoid delusions representing the severe end of a continuum. In this review we focus on the important advances following a decade of research from psychological sciences, and more particularly the work of Daniel Freeman and Philippa Garety in England. Their work has demonstrated that a range of causal factors are involved in the development and maintenance of delusions beyond the traditional cognitive and behavioural models. Indeed, there is now well-validated evidence that sleep disturbances, worry proneness, reasoning biases, such as failure to consider alternative explanations or belief confirmation bias, abnormal experiences such as hallucinations, negative self-beliefs, and safety behaviours, are central factors that contribute to the paranoid phenomenon. In this review, we describe each of these causal factors in detail as well as the clinical interventions developed by Freeman and his collaborators, including the integrative and modular “Feeling Safe” intervention. Broadly speaking, the aim of this psychological intervention is for patients to relearn safety by exposing them to situations they consider as potentially dangerous after reduction of the influence of the maintenance factors described above. A recent publication showed that the Feeling Safe program led to recovery in persecutory delusions for 50% of patients having poor response to antipsychotic medication, making the intervention as the most effective psychological treatment for persecutory delusions. Finally, we will critically discuss the efficacy data from the numerous clinical studies validating its effectiveness. Prospects for the implementation of the Feeling Safe program in France also is discussed.

Threat-anticipatory defensive responses have evolved to promote survival in a dynamic world. While inherently adaptive, aberrant expression of defensive responses to potential threat could manifest as pathological anxiety, which is prevalent, impairing, and associated with adverse outcomes. Extensive translational neuroscience research indicates that normative defensive responses are organized by threat imminence, such that distinct response patterns are observed in each phase of threat encounter and orchestrated by partially conserved neural circuitry. Anxiety symptoms, such as excessive and pervasive worry, physiological arousal, and avoidance behavior, may reflect aberrant expression of otherwise normative defensive responses, and therefore follow the same imminence-based organization. Here, empirical evidence linking aberrant expression of specific, imminence-dependent defensive responding to distinct anxiety symptoms is reviewed, and plausible contributing neural circuitry is highlighted. Drawing from translational and clinical research, the proposed framework informs our understanding of pathological anxiety by grounding anxiety symptoms in conserved psychobiological mechanisms. Potential implications for research and treatment are discussed.

This study examined the relationship between the Contrast Avoidance Model (CAM; Newman & Llera, 2011) and impairment in the problem-solving process using an in-vivo laboratory-based problem-solving task. We also explored whether general emotional CA tendencies explained the relationship between trait worry and problem-solving outcomes. In this study, 185 participants (42 of whom met diagnostic criteria for generalized anxiety disorder) engaged in a problem-solving task, and reported outcomes related to ability to generate solutions, confidence in solutions, intention to implement solutions, and state anxiety levels. According to results, higher general emotional CA tendencies predicted significantly more difficulties on most problem-solving outcomes. Further, CA tendencies mediated between trait worry and some, but not all, problem solving outcomes. Overall, CA appears to be linked to problem-solving deficits, and may help to explain some of the association between trait worry and negative problem-solving outcomes.

Worry about crime has been linked to several detrimental outcomes including worse mental health. However, there has been little research on the association between worry about crime and loneliness, even though loneliness is increasingly being recognised as a serious public health issue. To address this deficit, this study examined the association between worry about crime and loneliness in nine countries of the former Soviet Union (FSU - Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine), using data from 18,000 respondents aged 18 and above that were collected during the Health in Times of Transition (HITT) survey in 2010/11. Results from a pooled logistic regression analysis showed that compared to those who reported no worry about crime, individuals with a high level of worry had significantly higher odds of loneliness (odds ratio [OR]: 1.43, 95% confidence interval [CI]: 1.17–1.75). Sex- and age-stratified analyses further showed that the association was observed in women with a mid (OR: 1.37, 95%CI: 1.10–1.71) and a high level (OR: 1.70, 95%CI: 1.33–2.17) of worry about crime but not in men, and that a high level of worry about crime was linked to loneliness in adults aged 35–59 (OR: 1.39, 95%CI: 1.02–1.91) and 60 and above (OR: 1.64, 95%CI: 1.12–2.40) but not in those aged 18–34. High levels of worry about crime are associated with loneliness in the FSU countries. Reducing crime and its associated worries may have important public health benefits in these countries.