INTRODUCTION:Generalised anxiety disorder (GAD) in older adults involves excessive worry and cognitive challenges. Verbal memory impairments is associated to hippocampal dysfunction, with cortisol and brain-derived neurotrophic factor (BDNF) being important in hippocampal integrity. Research on hippocampal volume and verbal memory in older adults with GAD is limited, with mixed findings. This study investigates verbal memory in older adults with GAD versus healthy controls, and relations with hippocampal volumes. METHODS:Participants included 49 adults with GAD (Mage = 65.82, SD = 3.94) and 49 controls (Mage = 67.73, SD = 4.11). Verbal memory was assessed using the California Verbal Learning Test Long Delay Free Recall, hippocampal volumes via MRI, BDNF from serum, and cortisol via saliva. We fitted a Bayesian multivariate linear regression with bilateral hippocampal volume as outcome measure, and predictors: age, gender, education, intracranial volume, IQ, BDNF, cortisol, SSRI use, CVLT Long Delay Free Recall (LD FR), CVLT Learning, and diagnostic status*CVLT LD FR interaction. RESULTS:A credible interaction showed better verbal memory associated to larger hippocampal volume in controls, but this relationship was attenuated in GAD. BDNF and cortisol were not credibly associated with hippocampal volume. CONCLUSION:Diagnostic status moderates verbal memory and hippocampal volume relations, suggesting a distinct neurocognitive profile in older adults with GAD compared to healthy controls.

Generalized anxiety disorder (GAD) is a severe and prevalent disorder among older adults. Cognitive behaviour therapy (CBT) is recommended treatment for GAD, but older adults benefit less than younger peers. Physical exercise has been suggested to improve treatment efficacy. We aimed to determine the efficacy of augmenting CBT with physical exercise for older adults with GAD. This randomised controlled trial included 50 participants (mean [SD] age 66.52 [4.09] years; 39 [78%] female) with GAD. Participants received individual CBT and were randomised to either physical exercise or telephone attention placebo. The main outcome measure was self-reported worry on the Penn State Worry Questionnaire (PSWQ). Secondary outcome measures were clinician-rated remission and self-reported symptoms of anxiety, depression, and quality of life. Although the interaction between time and condition was statistically nonsignificant, moderation analysis revealed that this interaction was significant for participants with low treatment credibility to CBT at baseline. Participants randomised to physical exercise were five times more likely to achieve reliable long-term worry-reduction than placebo control. We found significant differences in favour of physical exercise for secondary measures of depression and anxiety. Participants with better cognitive inhibition at baseline were more likely to achieve clinician-rated remission. Findings suggest that physical exercise augments CBT for older adults with GAD.

Executive functions (EF) decline with age and this decline in older adults with generalised anxiety disorder (GAD) may be influenced by heart rate variability (HRV), brain-derived neurotrophic factor (BDNF), and physical fitness. Understanding these relationships is important for tailored treatments in this population. In this study, 51 adults with GAD (M age = 66.46, SD = 4.08) and 51 healthy controls (M age = 67.67, SD = 4.04) were assessed on cognitive inhibition (Stroop task), shifting (Trails part 4), flexibility (Wisconsin Card Sorting Test - Perseverative errors), working memory (Digit Span Backwards), IQ (Wechsler Abbreviated Scale of Intelligence), high frequency HRV, serum mature BDNF levels, and VO2 max. Results indicated that participants with GAD exhibited better cognitive inhibition compared to controls, with no general reduction in EF. Cognitive inhibition was predicted by gender, HRV, and BDNF levels, while cognitive shifting was predicted by gender and IQ, and cognitive flexibility and working memory by IQ. The enhanced cognitive inhibition in GAD participants might stem from maladaptive use of this function, characteristic of GAD, or protection from EF decline due to normal HRV. Increased BDNF levels, possibly due to good fitness, or compensatory mechanisms related to the disorder, might also play a role. These findings highlight the complexity of EF and related mechanisms in GAD, highlighting the need for interventions that consider both cognitive and physiological factors for optimal outcomes.

ObjectivesStudies have found older adults report fewer anxiety symptoms than younger adults. As behavioral avoidance is theoretically associated with maintaining anxiety, this study sought to examine age-related differences in avoidance and anxiety in a cross-cultural sample of older (n = 60, 60-92 years) and younger adults (n = 70; 17-24 years).MethodsCommunity dwelling participants from Australia and the United States of America completed self-report measures of anxiety, worry, and depression. Participants also self-rated levels of avoidance to 133 common fearful situations using a card sort task.ResultsOlder adults reported significantly less avoidance of age-adjusted social and medical scenarios, more avoidance of aggressive scenarios, with no significant difference for animal or agoraphobic scenarios when compared to younger adults. Age-related effects were no longer significant in full models, in which the main effect of anxiety explained variance in avoidance for social, medical, animal, agoraphobic, but not aggression scenarios.ConclusionsAge differences in avoidance behavior were accounted for by differences in anxiety symptoms, except for avoidance of aggressive scenarios, which was not associated with anxiety. CLINICAL IMPLICATIONS: Age differences in levels of avoidance of common fearful situations were found, and may be associated with differences in anxiety symptom severity.

The COVID-19 pandemic brought a mental health crisis, with depression symptoms increasing nearly three-fold compared to pre-pandemic levels. To explain this surge and to outline related novel treatment targets for post-pandemic psychiatric interventions, the current study examined cognitive, emotional, and behavioral predictors of depression (in the context of the recent pandemic). Participants completed measures assessing perceived danger, perceived infectiousness, and fear of the coronavirus (COVID-19). Participants also reported symptoms of depression and behavioral tendencies: pandemic-related compulsive checking, cleaning, and avoidance (of activities, situations, places, and people). A multiple mediation model revealed that the relationship between perceived infectiousness of the virus and depression was atemporally mediated by fear of the virus and pandemic-related avoidance of activities, situations, places, and people. Furthermore, avoidance played a uniquely important role in the mediation model. First, it directly mediated the relationship between perceived infectiousness and depression, even when omitting fear from the model. Second, avoidance was a discriminant predictor of depression, as neither pandemic-related checking and reassurance-seeking nor cleaning behavior mediated the relationship between cognition and depressive symptoms. Clinical implications are discussed, including how addressing the relationship between anxiety about viral infections and depression can prospectively increase treatment success as we move beyond the pandemic.

Objective: During public health emergencies such as the ongoing COVID-19 illness pandemic, it is essential to rapidly disseminate crisis messages which often contain embedded health directives. This study investigated which of three variants of the same messages (neutral tone, positive/compassionate tone, negative/fear-inducing tone) were most likely to motivate readers to engage in the health behavior proscribed in the message. Participants: Participants were 87 female and 41 male undergraduates at an urban university in the northeast U.S. Methods: A survey with three versions of eight different COVID messages containing health directives was administered. Results: Those who indicated stronger influence of positive/compassionate crisis messages (i.e., had higher Crisis Messages Survey scores) had higher adaptive health engagement scores, lower worry scores, and were likely to have had a past diagnosis of COVID-19. Moreover, a regression model including COVID-19 status and worry scores accounted for a significant proportion of variance in Crisis Messages Survey scores. Conclusions: Findings indicate that the use of neutral and compassionate language is optimal in motivating health behaviors embedded in university crisis messages.

Following the publication of our article [1], we have become aware of one error in the exclusion criteria, inconsistencies in Figure 1 and Figure 2, and a typo in the reference list.

Mental health concerns have increased in prevalence since the beginning of the COVID-19 pandemic. Many turn to online resources for relevant information. The purpose of this study is to describe the availability of mental health information on YouTube, and to assess the relevance of the videos’ content in relation to the actual need of the population. The 100 most-watched YouTube videos in English resulting from a YouTube search of “COVID-19” and “mental health” were evaluated. Of mental health conditions, anxiety and depression were mentioned in over 50% of the videos. A positive correlation was found between videos that mentioned anxiety and those that mentioned depression (p < 0.001). The numbers of videos focused on anxiety and depression were correlated with themes such as life stressors and social distancing (p < 0.05). Videos that did not make recommendations for dealing with stressors had more positive ratings than videos that did make such recommendations (p = 0.002). The content of YouTube videos addressing mental health issues during COVID-19 reflects the actual prevalence of specific mental health conditions during this same time period. Viewer ratings may be indicative of the public need for information about mental health conditions and validation for difficult experiences on social media sites. YouTube must be better utilized to disseminate information about mental illness.

Objective The COVID-19 pandemic of 2020 raised concern for those spending time in college classrooms and dormitories. Students faced sudden changes to their lives and relied upon written messages for directives. This study investigated the language of university-based communications, based on models of crisis communication and epidemic management. Methods The Linguistic Inquiry and Word Count was used to investigate the language in the most salient written messages from universities to students regarding the migration to online classes. Results As predicted, certain word types were used more frequently than others. The larger the student body, the more frequently universities used positive emotion/resilience and power/organizational words. and the more likely a COVID update would be posted on the homepage within three months' time. Conclusion Messages should be guided by models of crisis management and carefully crafted, given the role of universities in managing large numbers of students during ongoing pandemic illness.

Cognitive-behavioral therapy (CBT) is widely recognized as an efficacious treatment of anxiety and related disorders—however, recent research suggests that some older adults may derive reduced benefit from CBT as compared to younger adults. Age-related declines in cognition (e.g., memory, attention) may be a contributing factor to the reduced benefit seen in this population. Augmentation strategies for optimizing CBT are now under way (e.g., exercise, medication), and indicate that cognitive support and enhancement strategies can improve both cognitive skills and treatment outcome in anxious older clients. This review discusses the current literature on enhancement strategies that target CBT aptitude directly (e.g., memory aids for therapeutic material) and indirectly (e.g., use of standardized cognitive tasks unrelated to CBT) as methods of augmenting CBT. Recommendations for clinicians and directions for future research are provided.

Smartphone use in the older population is understudied, despite a growing use of technology in this age group. This study characterized the relation of demonstrated smartphone expertise to self-reported health attitudes and behaviors in 85 community-dwelling adults, mean age 77.24 (7.64) years. Self-report instruments included a demographic survey, a health attitudes measure, and a mobility checklist. Participants completed a behavioral challenge, the Smartphone Task for Older Adults (STOA). Demonstrated expertise in smartphone use (STOA-DESU), familiarity with apps, and ability to replicate functions after demonstration showed differential relations with health outcomes. DESU was positively associated with education, income, Altarum Consumer Engagement Measure (ACE), and Life Space Questionnaire (LSQ) scores and was negatively associated with age and daily medications. Additional findings replicated aspects of the well-known digital divide, and showed that those older adults with restricted mobility or diabetes had less knowledge of and more difficulties in using smartphones. Despite these problems, health-related functions must be optimized for older populations.

OBJECTIVE: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). DESIGN:Longitudinal assessment of GAD symptoms pre- and posttreatment. PARTICIPANTS:Participants were 259 older adults aged 60-86 years with a diagnosis of GAD who were assessed before and after treatment. INTERVENTION:Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions. MEASUREMENTS: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: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. CONCLUSIONS: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.

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BackgroundCOVID-19 testing remains an essential element of a comprehensive strategy for community mitigation. Social media is a popular source of information about health, including COVID-19 and testing information. One of the most popular communication channels used by adolescents and young adults who search for health information is TikTok—an emerging social media platform. ObjectiveThe purpose of this study was to describe TikTok videos related to COVID-19 testing. MethodsThe hashtag #covidtesting was searched, and the first 100 videos were included in the study sample. At the time the sample was drawn, these 100 videos garnered more than 50% of the views for all videos cataloged under the hashtag #covidtesting. The content characteristics that were coded included mentions, displays, or suggestions of anxiety, COVID-19 symptoms, quarantine, types of tests, results of test, and disgust/unpleasantness. Additional data that were coded included the number and percentage of views, likes, and comments and the use of music, dance, and humor. Results The 100 videos garnered more than 103 million views; 111,000 comments; and over 12.8 million likes. Even though only 44 videos mentioned or suggested disgust/unpleasantness and 44 mentioned or suggested anxiety, those that portrayed tests as disgusting/unpleasant garnered over 70% of the total cumulative number of views (73,479,400/103,071,900, 71.29%) and likes (9,354,691/12,872,505, 72.67%), and those that mentioned or suggested anxiety attracted about 60% of the total cumulative number of views (61,423,500/103,071,900, 59.59%) and more than 8 million likes (8,339,598/12,872,505, 64.79%). Independent one-tailed t tests (α=.05) revealed that videos that mentioned or suggested that COVID-19 testing was disgusting/unpleasant were associated with receiving a higher number of views and likes. ConclusionsOur finding of an association between TikTok videos that mentioned or suggested that COVID-19 tests were disgusting/unpleasant and these videos’ propensity to garner views and likes is of concern. There is a need for public health agencies to recognize and address connotations of COVID-19 testing on social media.

There is a pressing need to integrate mobile technology into the treatment of common mental health problems of later life such as anxiety and depression. However, adults over the age of 65 vary greatly in their mastery of smartphones. This study characterizes an older community-dwelling sample in terms of their varying levels of demonstrated smartphone expertise relative to anxiety, depression, and self-perceived proficiency in using technological (tech) devices. A 20-step behavioral smartphone challenge task, the Smartphone Task for Older Adults, was used to evaluate older adults’ knowledge of a range of smartphone functions. Findings diverge in potentially meaningful ways from previous studies using self-report measures of tech expertise. Scores on the task were relatively low and partly replicated the digital divide, but also indicate negative relations of demonstrated smartphone expertise with specific variants of anxiety and in-vivo frustration, rather than anxiety or depression more generally. Tech-related anxiety and frustration while attempting new smartphone functions may characterize the current cohort of older adults who have not effectively mastered use of smartphones. Implications for smartphone training tailored to this older subgroup are discussed.

Background Due to close proximity in dormitories, classes, and social activities, college students have been identified as a vulnerable population throughout the COVID-19 pandemic of 2020. Objectives This study tested properties of a new COVID-19 Inventory (C-19-I). It was expected that the measure would show acceptable validity and reliability, females would report greater COVID-19 anxiety than males, and the addition of gender would improve a regression model of COVID-19 anxiety. Method Participants were 201 college undergraduates who completed multiple self-report measures and two snack selection tasks. Results The C-19-I showed a multifactor solution and acceptable psychometric properties. Females scored higher than males and were more likely than males to select a healthy snack after responding to questions about illness and contamination. Conclusions This study validates a new measure of COVID-19 anxiety and contributes to a deeper understanding of how college adults respond to pandemic illness.

Crisis communication is most effective when it takes into consideration the emotional reactions of those involved. Messages pertaining to pandemic illness such as COVID-19 should thus include the most effective types of words, given the goal of crisis management. This study investigated hypothesized word categories (e.g., reward/risk, focus on present versus past) related to superordinate categories of positive and negative emotional tone in COVID-19 fact sheets from each of the fifty states in the U.S. The relation of six word types to the superordinate categories and a health outcome variable (the rate of deaths per positive virus cases) was also tested. Results indicated that each of the six word types mapped on to either the positive or negative emotion word category. Furthermore, messages that included more reward and uncertainty words were associated with lower deaths per positive virus cases. Implications for future pandemic crisis messages are discussed.

OBJECTIVES:Older adults vary greatly in their mastery of state-of-the-art smartphones. Anxiety may function as a barrier to technological expertise. This study characterizes an older community-dwelling sample (n = 71) in terms of their levels of demonstrated smartphone expertise relative to variants of anxiety (e.g., trait, social, tech-related). METHODS:A 20-step behavioral smartphone challenge task, the Smartphone Task for Older Adults (STOA), was used to evaluate older adults' knowledge of a range of smartphone functions. Self-report measures of anxiety symptoms and perceived digital proficiency were also administered. RESULTS:STOA scores were relatively low (x = 8.26, s.d. = 5.65) and showed negative relations with tech-anxiety and in-vivo frustration, but not social or trait anxiety. A hierarchical regression model indicated that tech-related anxiety and in-vivo frustration contributed significantly to STOA scores, above and beyond established predictors such as education. CONCLUSIONS:Tech-anxiety and frustration while learning new smartphone functions may characterize the next cohort of older adults who have not effectively mastered the use of smartphones. CLINICAL IMPLICATIONS:Anxiety management skills derived from cognitive behavior therapy and other self-regulation tools could help those who experience tech-anxiety or frustration during smartphone training, facilitating the development of expertise.

The COVID-19 pandemic first became evident at the end of 2019, and because of the many unknown aspects of this emerging infectious disease, the internet quickly became a source of information for consumers. It is important for any vital information to be written unambiguously, and at a level that can be understood by all people regardless of education levels. The purpose of this study was to assess the readability of 50 sources of COVID19 testing information online. Only 6 websites out of 50 received an appropriate readability score on more than one assessment. One-sample, one-tailed t-tests (α = 0.05, df = 49) were used to see if the websites with information on COVID-19 testing are being written at appropriate reading levels. The resulting p-values indicate that each p-value recorded is substantially below 0.05, it is very unlikely that websites on this topic are being written at the recommended levels. Even the optimal messages on COVID-19 reflect a confusing and rapidly changing public health crisis, however if messages are kept simple and clear, individuals will have the best possible chance of optimizing behavioral mitigation strategies. These are compelling reasons for informational hosts to take necessary steps to ensure that messages are written in as simple terms as possible. To this end, it is suggested that internet sites dispersing COVID-19 testing information build in text analysis methods for all published messages, particularly those meant to inform best health practices in the time of a pandemic.

Background The tendency of parents to consume alcohol during the COVID-19 pandemic is likely to be moderated by pandemic-related stress combined with the ongoing demands of childcare and home-based education, which are reported to be more burdensome for females than males. Objective The purpose of this study was to describe alcohol-related content posted by mothers on Instagram during the COVID-19 pandemic. Methods Using two popular hashtags, #momjuice and #winemom, 50 Instagram posts on each were collected from the “top posts” tab. The coding categories were created inductively and were as follows: displays alcohol (drinking/holding alcohol or alcohol itself), person is making alcoholic beverages, type of alcohol featured or discussed, highlights anxiety and/or depression/mental state, highlights struggling (in general), highlights parenting challenges, encourages alcohol consumption, discourages alcohol consumption, features a person wearing clothing or shows products promoting alcohol, promotes alcohol rehabilitation, highlights caffeine to alcohol daily transition throughout the day, and highlights other drugs besides caffeine and alcohol. Results Overall, the 100 selected posts had a total of 5108 comments and 94,671 likes. The respective averages were 51.08 (SD 77.94) and 946.71 (SD 1731.72). A majority (>50%) of the posts reviewed encouraged alcohol consumption (n=66) and/or displayed alcohol (n=56). Of the 66 that encouraged and/or displayed alcohol, the common type of alcohol discussed or featured was wine (n=55). Only 6 posts discouraged alcohol use and only 4 provided the audience with a disclaimer. None of the videos promoted or endorsed alcohol rehabilitation in any way. Only 37 posts highlighted struggle. However, these posts garnered more than a majority of the likes (n=50,034, 52.3%). Posts that showed struggle received an average of 1359.57 (SD 2108.02) likes. Those that did not show struggle had an average of 704.24 (SD 1447.46) likes. An independent one-tailed t test demonstrated this difference to be statistically significant (P=.0499). Conclusions The findings of this investigation suggest that though these hashtags ostensibly exist to valorize excess alcohol consumption, they may be serving as a support system for mothers who are experiencing increased burdens and role stress during the pandemic. Given the strains placed on mothers overall and especially during the COVID-19 pandemic, efforts must be taken to increase access to and affordability of telehealth-based mental health care.