Anxiety research articles


I have found this to be helpful in individuals with transient grief reaction, episodic stress, and anxiety as well. Right on the mark. Even HR departments like ours encourage these practices just as a way to foster positive well-being of our employees. A little Yoga goes a looong way in supporting emotional health. This is interesting for dealing with depression and high anxiety. Meditation makes you focus on your work present work, whatever work it is.

Forget about past, regrets of past and everything. Everyone suffers with Stress at some point of time and it was unavoidable for many of the people. Meditation has been used for many years and it was very helpful in reducing stress, anxiety. Mindful meditation will relaxes your mind and body brings to a peaceful,calm state. I discovered meditation while I lived in India. It has become a great tool for me to relax and focus on the important things in life. Great post. I think your mom would know about the actual benefit of mindful meditation.

Meditation gives you freshness, the freshness of the present and makes you forget about the bad incidents of past. Meditation is the best stress buster. A 20 minute meditation mindful releases all your stress up to that minute. A very informative and interesting article in the way that it not only tries to help us to know the importance of meditation but also tries to emphasise on how it helps us to have a better control on our breating as well.

Mindful Meditation can be wonderfully calming, anytime when the daily grind is getting on top of you. Just ten to twenty minutes can leave one feeling invigorated and serene. It can also help build positive emotions which are linked to better health, longer life, and greater well-being.

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Giving yourself a wonderful yet simple treat or something to look forward to at the end of the day helps as well! Your Mom knows what she is saying. Learning from our parents and seniors and acknowledging their accomplishment at survival, internalizing their triumph amidst loss and challenges can help us younger not so younger ones a lot.

We need to maintain our roots! As i was thinking.. Great Info. The cognitive models of social anxiety clearly emphasize the importance of how the individual thinks he or she is perceived by others and do not predict stable negative self-evaluations in persons with social anxiety disorder [16] , [17]. In fact, Clark and Wells [16] specifically mention that assumptions about the self are different in socially anxious individuals compared to depressed persons as the former group generally does not view themselves as inadequate in general, but that negative perceptions are mainly related to the feared social situation.

Persons with depression, on the other hand, are more likely to have stable assumptions or schemata regarding negative self-evaluation [16]. Prior literature investigating the association of social anxiety to internal shame suggests a moderate association. Studies by Fergus et al. The same magnitude of correlations were found in a recent study by Matos et al. In these studies, guilt was unrelated to psychiatric symptom burden leading to the conclusion that shame-free guilt probably has several highly adaptive functions [7] , [11].

In the study by Fergus et al. The absence of association between social anxiety and guilt is expected from a theoretical perspective, as it plays no role in the dominant models of social anxiety. To our knowledge, very little data has been published on the relationship between internal shame and SAD. Although one study used data partly collected from persons with SAD [11] , sample estimates were based on a pooled group comprising participants with different anxiety disorders making it difficult to assess the role of shame in SAD specifically.

SAD can be effectively treated with cognitive behavior therapy CBT , which has been shown in more than 20 randomized controlled trials [18]. One study showed that persons with an anxiety disorder undergoing intensive exposure-based treatment for two to three weeks made improvements in social anxiety and that these improvements were correlated with reductions of shame [11]. In addition, no prior study has investigated whether the treatment format, i. More knowledge in this regard could ultimately lead to a better understanding of social anxiety disorder and how CBT achieves its effect in the treatment of SAD.

In summary, shame and social anxiety have common features, but this association is stronger for external than for internal shame. The former is characterized by perceptions of unattractiveness in the eyes of others while the shame experience in the latter sense is marked by negative self-evaluations. Guilt is often discussed as an affect similar to shame, but evidence does not suggest that experience of guilt is related to psychopathology. The role of shame in patients with SAD is poorly investigated and it is unclear whether internal shame is elevated in these persons.

In addition, the knowledge on the effects of CBT on internal shame is scarce. The aim of this study was to investigate the association of internal shame, guilt, depressive symptoms, and social anxiety. The specific questions that we sought to answer were:. We hypothesized that internal shame, but not guilt, would be moderately associated with social anxiety. To investigate the association of shame and social anxiety two types of comparisons were made.


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The latter sample was better matched on demographic characteristics and is denoted the replication sample. Second, we investigated the extent to which measures of internal shame, guilt, depressive symptoms and social anxiety were correlated among the patients with SAD.

Understanding different aspects of an anxiety research paper

To investigate the effect of CBT on internal shame, a within-group pretest-posttest design was used where the patients with SAD were assessed on measures of shame directly before treatment and at one-year follow-up. Clark and colleagues [19]. Participants received treatment within the context of a randomized controlled trial RCT. The main results of that study have been reported elsewhere [20]. The main inclusion criteria were that participants had to have a principal diagnosis of SAD according to DSM-IV as assessed using the SCID [21] , be between 18 and 65 years of age, and have no history of bipolar or psychotic disorder.

Table 1 provides data on demographic characteristics of the sample. The healthy controls were students at the department of psychology at Stockholm University, Sweden.

Stress and anxiety

Healthy controls were recruited at two separate occasions. There were 72 participants in the main control sample and 22 participants in the replication sample, i. Thus, there were 94 controls in total. Control participants provided assessments at one occasion only and did not receive treatment with CBT. Demographic data on the sample is presented in Table 1. As shown in Table 1 , there were significant differences between SAD participants and the healthy control main sample in terms of age and gender, i. However, there were no significant differences between the SAD participants and the healthy control replication sample on these variables.

The TOSCA also assesses externalization, pride and, detachment, but these constructs are not reported in the present paper. The instrument is comprised of a description of 15 different situations and the respondent rates to which extent he or she agrees with suggested potential reactions relating to shame and guilt.

Each item response is scored on a Likert scale 1—5 and the total scale range for shame and guilt is 15 to As described by Gilbert [7] , the scale consists of items relating to self-evaluation feeling stupid , shame behaviors avoid eye contact , and affect self-disgust. This treatment is based on the cognitive model as elaborated by Clark and Wells [16] and emphasizes the role of self- focused attention, safety behaviors and dysfunctional assumptions as maintaining factors of social anxiety.

Journal of Anxiety Disorders

All CBT entailed the same components which were the following: a deriving an individualized version of the cognitive model using patients' thoughts, images, anxiety symptoms, safety-behaviors and attentional strategies, b conducting a behavioral experiment to demonstrate the adverse effects of safety behaviours, c using video feedback to modify distorted self-imagery, d training externally focused attention i.

In the individual format participants received 16 weekly sessions.

Group CBT was led by two therapists and comprised 17 sessions and there were 6—7 participants in each group. Group CBT was in an intensive format, which meant that all 17 group sessions were delivered in three weeks time. Seven therapists five psychologists, one nurse and one psychiatrist delivered the treatments. To facilitate treatment integrity, all therapists received supervision throughout the treatment period by an experienced clinical psychologist and sessions were videotaped and checked for integrity during supervision.

The RCT study was approved by the regional ethics review board in Stockholm and conducted in accordance with the guidelines of the Declaration of Helsinki. Participants in the clinical sample, i. Verbal informed consent for healthy controls was viewed as sufficient as these participants were exposed to minimal risk of adverse events. That is, they only completed two relatively brief self-report questionnaires anonymously, and underwent no psychiatric assessment or any form of intervention. All analyses were conducted using SPSS version Continuous data were analyzed using Pearson correlations zero-order and partial , linear regression models, and independent and paired samples t-tests.

Analysis of patterns of missing data were conducted using Little's Missing Completely at Random Test [32]. Missing data were imputed using linear regression estimation methods using the available covariates as predictors. As the missing value analysis showed that data were missing completely at random and imputation of missing data had no significant effect on the obtained estimates, the presented results are based on observed data, i.

Power to detect baseline to post-treatment differences 0. Effect sizes were, Cohen's d , were calculated based on pooled SDs. In the control group there was no data loss. As the groups differed in terms of age and gender, we also analyzed between group differences using a linear regression model controlling for age and gender. The results from the analyses comparing SAD participants with the healthy control replication sample yielded a different picture.

Table 3 entails the intercorrelation matrix of measures of shame, guilt, social anxiety, and depressive symptoms for the SAD participants. To investigate whether depressive symptoms and social anxiety were uniquely associated with shame partial correlations were conducted controlling for depressive symptoms and social anxiety, respectively. In short, in comparison with the main control sample, participants with SAD had similar shame scores at baseline but lower scores at follow-up, but in comparison with the control replications sample they had higher levels of shame at baseline but similar levels of shame after treatment with CBT.

As reported in the article of the original RCT [31] and shown in Table 2 participants made significant improvements from baseline to follow-up on measures of social anxiety and depressive symptoms, i. As the participants with SAD were randomized to receive CBT in an individual format or in a group format, we also investigated whether mode of delivery moderated the association between shame and social anxiety.

An additional finding was that baseline shame predicted pre-to post-treatment change in social anxiety as assessed with LSAS-SR, i. Thus, shame played a role both as predictor of outcome and as a variable that followed the change pattern of social anxiety among participants with SAD in the group CBT. However, shame had no such effects in individual CBT. The aim of this study was to investigate the interrelations of shame, guilt, social anxiety, and depressive symptoms by comparing persons with SAD with healthy controls, and by investigating the effect of CBT for SAD on shame and guilt.


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  • The results showed a significant association of shame and social anxiety among participants with SAD, although there were conflicting results in terms of shame between groups, where the SAD sample had elevated shame in comparison to the healthy control replication sample, but not to the main control sample. As expected, CBT led to significantly lower levels of shame. In accordance with our hypothesis, guilt was unrelated to social anxiety both in terms of lack of difference between the SAD and the healthy control replication sample, and as indicated by the finding that there was no significant correlation between guilt and social anxiety within the SAD sample.

    However, there was a significant difference in guilt between the SAD and the main control sample, but this was in the opposite direction as controls had higher levels of guilt than participants with SAD. The results of this study suggest that the association between shame and social anxiety is fairly complex. First, it is quite clear that shame and social anxiety are not interchangeable concepts, which was not least demonstrated in the fact that there were minimal differences between SAD participants and healthy controls in the main sample.

    Nevertheless there was an association between social anxiety and shame within the SAD sample. How are these results to be understood? We believe that the differences between the two samples of healthy controls shed some light on these findings. When a new sample of controls was recruited that better matched the clinical sample a quite different picture emerged.

    In comparison to the replication control group the levels of shame were significantly elevated in the SAD group, and after effective treatment with CBT, the clinical sample was similar to the healthy control replication sample in terms of shame. This might reflect a true age effect on internal shame, but could also be an artifact driven by the construction of the TOSCA scale. This means that the samples are likely to be recruited from the same student populations but from different time cohorts. That is, had this study been conducted 10 years earlier the participants in the replication sample would have been part of the main sample.

    Generalized anxiety disorder and coping strategies

    Taken together this probably indicates that replication sample is a more valid control group. It is also worth noticing that a significant effect between the clinical sample and the replication sample in terms of shame was found despite power being reduced due to the smaller n of this control group, suggesting an at least moderately large between- group difference. Another important aspect to bear in mind when interpreting the findings of this study is that the TOSCA primarily assesses internal shame and not external. This means that the type of shame investigated pertains not the typical aspect of shame that one believes that others have negative perceptions about one-self, but concerns a more profound form of shame that is more related to self-perception.

    That is, it might be that shame is related to social anxiety both among persons with SAD and healthy controls but that protective factors among healthy controls reduce the effect of shame on social anxiety. This suggests that although internal shame is not explicitly targeted in CBT, the treatment affects processes relating to internal shame. It might be that skills acquired to challenge dysfunctional beliefs are used also to dispute thoughts concerning self-worth.

    That is, components aimed at reducing external shame are also used to reduce internal shame. Treatment modality moderated the effect of shame as a predictor and to which extent it was related to reduction of social anxiety. For participants receiving group CBT shame was associated with outcome, but no such effects were found among participants in individual therapy. A possible interpretation of these findings is that exposure to other persons with SAD has a large therapeutic impact on those with high internal shame as they become aware that other people have the same social fears.

    A clinical implication of these finding could be that group CBT is especially suitable for persons with SAD who have high levels of internal shame. Of course, these findings need to be replicated. A limitation concerning these findings is that a repeated measurements within-group design was used meaning that causality of CBT on the reduction of shame is uncertain. That is, it cannot be ruled out that a change in shame would have occurred also in the absence of treatment with CBT.

    However, as SAD as well as shame seem to be stable over time in the absence of treatment [33] , [34] , [35] , we regard it as likely that change in shame and social anxiety was related to the treatment received. Future studies should investigate whether this effect is specific for CBT or if it is found also in other psychological and pharmacological treatments of SAD.

    When comparing the degree of shame in this study to estimates found in other studies, it is just about in the same range as in the study by Fergus et al. Interestingly, the healthy controls in the latter study was comprised of a sample of university students as in the present study and their shame scores were nearly identical to the scores of the main control group in this study.

    Once again, as shame scores were significantly lower in the replication sample of our study, this might suggest that young students are not the best matches for typical adult clinical samples. In this study, social anxiety and depressive symptoms were shown to be independently related to shame, i. A possible explanation for this difference in results between the scales is that SIAS has a stronger emphasis on the emotional response, i.

    The finding that social anxiety and depressive symptoms were independently related to shame is slightly different compared to some previous research [11] that has suggested that correlation between depressive symptoms and shame could be explained by anxiety. Our finding could suggest that in order to reduce shame in the treatment of SAD it is important to address social fears as well as depressive symptomatology. As for guilt, the results were in line with our hypothesis that this construct would be unrelated to social anxiety.

    As stated above, the only statistically significant finding regarding guilt was that it was elevated in the main control sample compared to participants with SAD. These findings are similar to those obtained in previous studies [7] , [11] and add to the body of knowledge indicating that guilt is largely a non-pathogenic adaptive quality that fosters salutogenic restorative behaviors. This reduces the risk of losing precision as shame and guilt in everyday language are often confused, which could blur findings if participants are simply asked to report on feelings of guilt without further specification.

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    A general note when interpreting the findings of the present paper was that the study was carried out in a western-world context. As it has been shown that the significance of shame on anxiety in non-clinical samples could be moderated by ethnicity [36] , caution is warranted in terms of generalizability of the results to other cultural contexts. This study has some limitations. First, patients with SAD and healthy controls in the main sample were not matched on age and gender, which could have biased the results.

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