Early-life adversity is a major risk factor for psychopathology, but not all who experience adversity develop psychopathology. The current study evaluated whether the links between child and adolescent adversity and depression and anxiety were described by general benefits and/or buffering effects of interpersonal support. Data from 456 adolescents oversampled on neuroticism over a 5-year period were examined in a series of discrete-time survival analyses to predict subsequent disorder onsets. Models examined linear, quadratic, and interactive effects of interpersonal support over time, as measured by chronic interpersonal stress interview ratings. Results did not support buffering effects of interpersonal support against either child or adolescent adversity in predicting depression or anxiety. However, there was support for the general benefits model of interpersonal support as evidenced by follow-up analyses of significant quadratic effects of interpersonal support, demonstrating that higher interpersonal support led to decreased likelihood of depression and anxiety onsets. Secondary analyses demonstrated that effects of interpersonal support remained after accounting for baseline depression and anxiety diagnoses. Further, quadratic effects were driven by social domains as opposed to familial domains when considering child adversity. Implications for interventions and randomized controlled prevention trials regarding interpersonal relationships are discussed.

There is now considerable evidence that anxiety disorders aggregate in families. Whilst genetic heritability plays a part, environmental factors are another factor explaining this aggregation. However, little is known about the cognitive mechanisms involved. This study examined maternal attentional focus as a possible mechanism in a community sample of mothers of young infants, using an ambiguous scenarios paradigm. In particular, we examined whether more anxious mothers were more likely to interpret everyday scenarios concerning their young children as more threatening and whether this affected their predictions of their own reactions to the situations. Anxiety scores were associated with a greater likelihood of anxious interpretation in first-time mothers but not in the whole sample. Mothers who scored higher on state and trait anxiety were found to perceive ambiguous scenarios involving infants as more threatening than mothers scoring lower on anxiety and were more likely to indicate that they would seek external reassurance. These relationships were stronger when data were only analysed for the sub-group of first-time mothers. This suggests that anxious interpretations by the mother may ultimately influence the child's assessment of and response to threat. However, direct observational research is needed to examine this issue.

Background.Randomized clinical trials indicate a benefit from combining medications with cognitive behavioral therapy (CBT) relative to medication alone for panic disorder. Using an as-treated analysis, we evaluated whether the addition of CBT enhanced outcomes for panic disorder relative to medications alone in the primary-care setting.

Method.Primary-care patients with panic disorder reported on their receipt of CBT and medications over the 3 months following baseline assessment. The degree to which outcomes for those who used anti-panic medications were enhanced by the receipt of at least one component of CBT was analyzed using a propensity score model that took into account observable baseline patient characteristics influencing both treatment selection and outcomes.

Results.The addition of CBT resulted in statistically and clinically significant improvements at 3 months on anxiety sensitivity, social avoidance, and disability. Also, patients receiving CBT in the first 3 months of the study were more improved at 12 months than patients who took medications only during the first 3 months of the study.

Conclusions.The clinical utility of the findings are discussed in terms of the importance of primary-care physicians encouraging their panic disorder patients to receive CBT as well as medications.

Effects of structured worry interviews were examined among analog-GAD and nonanxious college students. Thirty-four analog-GAD and 29 nonanxious control participants generated sequences of possible catastrophic outcomes for each of six worry topics using the Catastrophizing Interview Technique (Vasey and Borkovec, 1992). Threat ratings for each topic were collected, and ratings of subjective distress, likelihood of the feared outcome, and perceived control over the feared outcome were obtained immediately following each interview. Results indicated that the analog-GAD group rated the worry topics of achievement, social relations, and economics as more threatening than their nonanxious counterparts. The analog-GAD group also generated more catastrophizing steps and reported higher levels of negative mood following the worry interviews. In addition, the eventual fear underlying each worry was determined by coding the content of the final outcome step from each interview. Results from the coded interview responses indicated that fears of negative emotion and of failure were the most frequently coded categories in each of the six topical domains for the analog-GAD group. Although there was no difference in the proportion of negative emotion codes between analog-GAD and nonanxious groups, the analog-GAD group did receive a greater proportion of failure codes than the nonanxious control group. Results largely replicated the findings of Vasey and Borkovec in an analog-GAD sample. In addition, results suggest that fear of negative emotion underlies worry in general, regardless of diagnostic status, while fears of failure or ineffectiveness are more specific to GAD.