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The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A).
Longitudinal assessment of GAD symptoms pre- and posttreatment.
Participants were 259 older adults aged 60–86 years with a diagnosis of GAD who were assessed before and after treatment.
Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions.
Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A.
Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status.
Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.
The purpose of this study was to assess the readability of information on the Internet posted about coronavirus disease 2019 (COVID-19) to determine how closely these materials are written to the recommended reading levels.
Using the search term “coronavirus,” information posted on the first 100 English language websites was identified. Using an online readability calculator, multiple readability tests were conducted to ensure a comprehensive representation would result.
The mean readability scores ranged between grade levels 6.2 and 17.8 (graduate school level). Four of the 5 measures (GFI, CLI, SMOG, FRE) found that readability exceeded the 10th grade reading level indicating that the text of these websites would be difficult for the average American to read. The mean reading level for nearly all noncommercial and commercial websites was at or above the 10th grade reading level.
Messages about COVID-19 must be readable at an “easy” level, and must contain clear guidelines for behavior. The degree to which individuals seek information in response to risk messages is positively related to the expectation that the information will resolve uncertainty. However, if the information is too complex to interpret and it fails to lead to disambiguation, this can contribute to feelings of panic.
The most widely studied behavioral model of fear is classical fear conditioning as it may be assessed across many different species, including humans. Conflicting signals can be divided in two basic categories: emotional and non-emotional. Cortical control of anxiety appears to be especially important in the presence of emotional stimuli. Human brain imaging studies have found insular abnormalities in anxiety patients. Patients with panic disorders display decreased gamma-aminobutyric acid (GABA A)/benzodiazepine sites in the insular cortex, while phobic patients show an increase in insular activity during the presentation of fearful faces. Serotonin plays an important role in the regulation of emotions, including anxiety, fear, and depression. The complex and important role that the serotonergic system plays in emotional regulation is also unambiguous. Serotonergic modulation occurs via interaction with a wealth of receptors with complementary and sometimes opposite effects acting at different levels in the circuitry underlying anxiety.
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