IntroductionIn Western culture, the female body is commonly socially perceived as an object of evaluation, causing women to frequently evaluate their self-worth based on their physical appearance. Since the last decade, the use of virtual reality (VR) helped clarify the intricate interplay between broader self-related dimensions and dysfunctional eating attitudes and behaviors in women with eating disorders (EDs). The first objective of this study explores the role of body image attitudes (i.e., perceived physical attractiveness, body shape concerns), global self-worth, and physical self-worth in determining visual-perceptual body image representations (i.e., allocentric and egocentric ideal and self-perceived body size) and visual-perceptual body image disturbances (i.e., allocentric and egocentric visual-perceptual body dissatisfaction) in a sample of women with EDs. Additionally, the second objective is to explore the role of body image variables (in terms of attitudes: perceived physical attractiveness, body shape concerns; and in terms of visual-perceptual body image disturbances), global self-worth, physical self-worth, in determining dysfunctional eating attitudes and behaviors (i.e., eating concerns, restraint, and bulimia) in women with EDs.MethodsThe sample involved 96 self-identified female participants. Pearson's bivariate correlations and multiple linear regressions analyses were conducted to investigate the study's objectives. A VR-based figure rating scale was used to perform visual depictive body size estimation tasks in an allocentric and egocentric perspectives.ResultsThe findings indicate that physical self-worth and shape concerns are the primary variables related to visual-perceptual body image dissatisfaction. Shape concerns is also associated with eating concerns.DiscussionThis study emphasizes the critical role of physical self-worth and shape concerns as common variables of interest in relation to both visual-perceptual body image representations and disturbances, as well as shape concerns for dysfunctional eating attitudes and behaviors. These findings clarify the understating of the intricate interplay between body image, broader self-related dimensions, and dysfunctional eating attitudes and behaviors in EDs.

OBJECTIVES:Several studies have shown the effectiveness of immersive virtual reality (IVR)-based relaxation techniques in alleviating stress within the general population. However, few data are available on patients, or on the effectiveness of different scenarios in inducing relaxation. This pilot study aims to compare the effectiveness of three relaxation techniques-preselected IVR (IVR-PS), preferred IVR (i.e. chosen by the participant from different alternatives-IVR-PR), and narrative alone (CTR)-in reducing physiological and psychological stress in 16 pulmonary arterial hypertension (PAH) female patients (N = 16, average age: 46 ± 10.66 years; average education: 13.31 ± 3.8 years; mean duration of illness: 8.56 ± 5.24 years) following an acute stress. METHODS:Patients performed a mental stress test followed by three different relaxation sessions presented in a randomized order on three separate occasions. Self-perceived stress, level of relaxation, and heart rate (HR) were monitored during the sessions. Participants' ratings of their experiences were also collected. RESULTS:The results indicated that the three relaxation methods were equally effective in reducing perceived stress induced by acute stress and in lowering HR. However, greater cognitive activation was reported in the two IVR conditions compared with the narrative condition. CONCLUSIONS:This is the first study to show evidence of the impact of IVR on a rare population. Despite the lack of significant differences between the two IVR and narrative-alone conditions in physiological and subjective relaxation, more than half of the participants expressed a subjective preference for the virtual experience, especially for the preferred one.

Abstract Background The Telehealth Intervention Program for Older Adults (TIP-OA) was a volunteer-based phone support program for to older adults during the COVID-19 pandemic. While volunteer-based phone programs can be effective in providing mental health support, there is limited data on the predictors of response to such interventions. This study aimed to examine clinical and demographic predictors of response to the TIP-OA intervention among older adults. Methods This secondary analysis of a prospective cohort study included 82 TIP-OA users who expressed interest in the program’s research component, met inclusion criteria, and provided informed consent. Participants completed both baseline and 8-week assessments or had 4-week data carried forward using the last observation carried forward (LOCF) method. The intervention consisted of weekly supportive phone calls over eight weeks. Baseline mental health risk level was assessed by clinicians during intake and categorized as low, medium, or high based on symptom severity within specific symptom categories. Associations between baseline risk level and changes in stress (primary outcome), depression, and anxiety (secondary outcomes) were examined. The primary outcome was measured by the Perceived Stress Scale (PSS; scores ranging from 0 (never) to 4 (very often)). Secondary outcomes were measured by the Patient Health Questionnaire-9 (PHQ-9; scores ranging from 0 (not at all) to 3 (nearly every day)), and the Generalized Anxiety Disorder-7 scale (GAD-7; scores can range from 0 (not at all sure) to 3 (nearly every day)). Results At 8 -week follow-up assessment, participants with higher baseline risk levels showed greater reductions in stress (mean difference in Perceived Stress Scale reduction by 2.13, (F(1,77) = 2.82, p = 0.09, 95% CI [−0.46, 5.56]) and depression (t(73) = −1.92, p = 0.059; Std. beta = −0.43, 95% CI [−0.87, 0.02]). Additionally, not identifying as a visible minority predicted lower stress scores, while male gender and a university education level were associated with greater reductions in depression scores. Conclusion TIP-OA participants with higher baseline mental health risk appeared to benefit more in terms of reductions in stress and depression. Non-minority status, male gender, and university education were also associated with better post-intervention outcomes in depression. Future studies should explore predictors of response in similar intervention programs through larger confirmatory studies. Trial registration Registered on clinicaltrials.gov (clinical trial no.: #NCT04523610) on 16/07/2020.

Background: A lack of access to culturally sensitive psychotherapy detrimentally impacts the mental health and wellbeing of Inuit in Quebec. Previously, we reported a co-creation process of a culturally adapted cognitive-behavioural therapy manual that incorporates salient cultural imagery with virtual reality (VR-CBT). In this proof-of-concept trial, we aimed to examine the feasibility and acceptability of our VR-CBT, and suitability of research methods for a future larger trial. Methods: We ran a mixed-method, one-arm proof-of-concept longitudinal trial (ISRCTN21831510) to assess feasibility. Some aspects of the protocol were changed in the initial phases to increase cultural and logistical alignment. Inuit living in Montreal who were interested in therapy and tolerated the VR headset attended a ten-week cognitive-behavioural therapy with a psychotherapist. They provided biweekly measures of emotion regulation, psychological wellbeing, and psychological symptoms. Feasibility markers were enrolment and attrition, with complementary qualitative interviews and questionnaires. Exploratory markers of effectiveness were emotion regulation, psychological wellbeing, and psychological symptoms. Results: We recruited twenty participants, which matched our expectations. Ten Inuit attended at least one therapy session, with the majority completing five of the ten sessions. The recruitment, enrolment and conduct of the therapy itself were promising. However, attrition was high, randomization was unfeasible, and several aspects of the original protocol modified. The results indicated a trend towards improvement in outcomes. Conclusions: Our trial demonstrates the promise of delivering culturally adapted and technology-assisted therapy. We undertook a collaborative research process, recruitment, and therapy delivery, and gained knowledge of how to improve the feasibility of culturally sensitivity digital mental health. The project highlighted the challenges of conventional trial designs required by funders in evaluating effectiveness of psychotherapy in Indigenous contexts. Trial Registration Number: International Standard Randomized Controlled Trial Number (ISRCTN) 21831510; https://www.isrctn.com/ISRCTN21831510

Background: Police and security professionals are routinely exposed to potentially traumatic events as part of occupational duties, placing them at increased risk for post-traumatic stress and broader psychological difficulties. This study aimed to identify latent classes of proximal traumatic exposure among Portuguese police/security professionals and examine their associations with PTSD symptoms and general psychological distress. Methods: A cross-sectional online survey was conducted with Portuguese police/security professionals (N = 644). Latent class analysis (LCA) was applied to 17 indicators of potentially traumatic events coded as directly experienced or witnessed, derived from the Life Events Checklist for DSM-5. PTSD symptoms were assessed using the PTSD Checklist for DSM-5, and general psychological distress was assessed using the Brief Symptom Inventory. Exploratory receiver operating characteristic (ROC) analyses examined whether counts of proximal traumatic events could approximate the LCA-derived classes. Results: A three-class solution was identified, comprising low proximal exposure (37.3%), moderate proximal exposure (40.7%), and high proximal/cumulative exposure (22.0%) classes. The classes reflected a graded cumulative pattern of exposure across traumatic event categories, rather than clearly distinct qualitative configurations defined by specific event types. Higher exposure classes were associated with progressively higher PTSD symptoms and psychological distress, and these associations remained significant after adjustment for sociodemographic and occupational variables. Exploratory receiver operating characteristic (ROC) analyses showed that a simple count of proximal traumatic event categories closely approximated the empirically derived class structure within the present sample. However, the resulting thresholds are sample-specific, exploratory, and should not be interpreted as validated screening cutoffs. Conclusions: Proximal traumatic exposure among police/security professionals appears to follow a graded cumulative structure associated with increased PTSD symptoms and psychological distress. The person-centered analysis provided an empirical test of whether exposure was organized according to qualitatively distinct event configurations or primarily along a cumulative gradient. In this sample, cumulative exposure burden emerged as the dominant organizing dimension. The count-based approximation requires external validation before any screening or decision-making application can be considered.

PURPOSE:Speaking in class is challenging for students who stutter. Cognitive-behavioral therapy (CBT) with exposure in virtual reality (VR) emerges as a promising intervention for treating speaking anxiety in pediatric populations. This pilot study tested if real-time avatar-based VR can elicit anxiety responses while remaining acceptable to youth who stutter. METHOD:Twelve students who stutter (aged 9-18) were randomly assigned to a single training session conducted either (1) in VR with a realistic avatar controlled live by their SLP, or (2) in role-play with their SLP, before facing a real actor. We assessed system acceptability, anxiety levels and perceived self-efficacy. RESULTS:The VR system was well accepted and elicited physiological arousal comparable to real-life interactions. Although participants reported experiencing less anxiety during VR, skin conductance level showed higher arousal; suggesting a divergence between the subjective report and physiological response. Finally, one training session (either in VR or with the SLP) did not produce gains in self-efficacy or decrease in anxiety related to the final real-actor conversation. CONCLUSION:This study demonstrates evidence that the potential use of immersive VR could represent an acceptable and viable complementary strategy for SLP treatment, that could control exposure parameters while evoking physiological responses similar to real-life contexts. The differences between subjective and physiological measures suggest that VR is inducing anxiety responses differently than it was perceived. Further research could investigate the use of VR as anxiety interventions for students who stutter and should be explored across multi-session studies to understand their therapeutic effect.

Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) is widely regarded as the gold-standard psychological treatment for obsessive-compulsive disorder (OCD). Inference-based cognitive behavioral therapy (I-CBT) represents a distinct cognitive approach that targets inferential confusion, defined as a reasoning process whereby imagined possibilities are treated as reflecting reality, without relying on deliberate exposure. The present study reports further mechanism-focused analyses from a previously published multicenter randomized controlled trial (Aardema et al., 2022; ClinicalTrials.gov Identifier: NCT01794156) comparing CBT with ERP, I-CBT, and mindfulness-based stress reduction (MBSR) for OCD. A total of 111 participants with a primary diagnosis of OCD were randomized to one of three treatment conditions. Across treatments, therapy was associated with significant reductions in inferential confusion and obsessive belief domains, whereas dispositional mindfulness did not show significant change. At the bivariate level, residualized changes in inferential confusion, obsessive belief domains, and mindfulness were associated with reductions in OCD symptoms. However, when examined concurrently using mixed-effects models, only reductions in inferential confusion accounted for unique symptom improvement over time. This association was consistent across modalities and remained robust after controlling for concurrent anxiety and depression. Sensitivity analyses indicated that psychotropic medication use did not account for this association; controlling for medication strengthened the independent contribution of inferential confusion (partial η2 ≈ .29). These findings indicate that inferential confusion was independently associated with symptom improvement in OCD across therapeutic approaches.

Background: Digital mental health (DMH) has grown exponentially; however, its therapeutic effects, while impressive, may exclude marginalized populations. Aims: We investigated the feasibility, acceptability and impacts of a culturally adapted DMH for Inuit in Quebec. Methods: The longitudinal trial is grounded in interpretative phenomenology and participatory action methodologies. We interviewed seven trial participants over the course of the study for a total of k=12 brief, semi-structured interviews. The therapist was also interviewed in-depth at the conclusion of recruitment. Triangulated data were analyzed with reflexive thematic methodology. Results: Six themes emerged. We discuss therapeutic effects and participant perceptions of the culturally adapted virtual environments and biofeedback. We also discuss expectations and knowledge about therapy, how adapted and sensitive the therapy was to Inuit, issues with study feasibility, relationships between therapist, research team and participants, and the perceived impacts of the therapy. Conclusions: We conclude with discussion and recommendations for stakeholders that are generalizable across DMH, VR, and culturally adapted projects. Trial Registration Number: International Standard Randomized Controlled Trial Number (ISRCTN) 21831510; https://www.isrctn.com/ISRCTN21831510

Professionals working in high-risk occupations, such as firefighters and emergency medical personnel, are repeatedly exposed to potentially traumatic events that may affect both psychological functioning and decision-making under pressure. However, psychological responses to occupational stress are heterogeneous, and their implications for performance remain insufficiently understood. The present study adopted a person-centered approach to examine latent profiles of psychopathological symptoms and their associations with emotional, social, and behavioral functioning in a virtual reality (VR) emergency simulation. A sample of 395 Portuguese firefighters completed the Brief Symptom Inventory (BSI), measures of emotion regulation difficulties, posttraumatic stress symptoms, and perceived social support, and performed a VR-based medical emergency task assessing decision-making accuracy under stress. Latent profile analysis identified four distinct symptom profiles: Low Psychological Distress, Moderate Internalizing Distress, High Global Psychological Distress, and Mixed / Interpersonal Distress. Profiles differed significantly in emotion regulation difficulties, posttraumatic stress symptoms, perceived social support, and VR task performance. Notably, individuals characterized by a Mixed / Interpersonal Distress profile, marked by elevated interpersonal sensitivity, hostility, and paranoid ideation, committed significantly more decision-making errors in the VR simulation than those in the Low Psychological Distress profile. In contrast, high global psychological distress was not uniformly associated with poorer performance. These findings suggest that decision-making under stress in emergency contexts is shaped less by generalized psychopathology and more by specific interpersonal and affective symptom configurations. The study underscores the value of person-centered approaches and immersive VR methodologies for identifying psychologically meaningful risk patterns, with important implications for assessment, training, and targeted intervention in emergency service professions.

This study used data from a randomized control trial on cognitive behavior therapy for social phobia testing the effectiveness of exposure conducted in virtual reality. Measures of cognitive mechanisms had been collected but never analyzed. The study was motivated by a recent publication mentioning that potential aversive outcomes of being judged in virtual reality and by virtual characters have no objective negative consequence in daily life. A sample of 51 adults completed outcome and cognitive mechanism measures at a pretreatment, after 14 weeks of treatment or being on a waiting list, and at a 6-month follow-up. Results demonstrate that conducting exposure in virtual reality led to reductions in dysfunctional beliefs about the perceived consequences of feared social threats, about the likelihood of these feared threats occurring, as well as an increase in perceived self-efficacy to face social situations. These changes were statistically significant when compared to the waiting list condition, remained stable at the 6-month follow-up, and were no less important than when exposure was conducted in vivo. All predictors significantly correlated (p <.001) with the two measures of treatment outcome. Further analyses of cognitive mechanism measures predicting treatment outcomes revealed that, when controlling for shared variance, changes in perceived likelihood and in self-efficacy contributed significantly to patients' improvement, whereas the role of perceived consequences was only a predictor of self-efficacy.

Background/Objectives: Physical activity alleviates symptoms and may slow Parkinson's disease (PD) progression, yet many individuals with PD remain sedentary. Kinesiophobia, the fear of movement, may represent a significant but underexplored psychological barrier to physical activity in this population. Virtual reality (VR), already effective in phobias, may represent a promising approach to address this challenge. This review initially aimed to systematically examine exposure-based interventions in VR (E-IVR) directly targeting kinesiophobia in PD. Methods: Database searches using keywords such as "kinesiophobia," "fear of movement," and "VR" combined with "PD" yielded no eligible studies. Consequently, the scope was broadened to include populations with neurological or musculoskeletal conditions, and a narrative review format was adopted to synthesize the available evidence. Furthermore, relevant studies of interventions in VR applied in PD, although not specifically addressing kinesiophobia, are detailed to provide evidence of efficacy and feasibility of VR interventions in PD. Finally, directions are offered to support the creation of E-IVR targeting kinesiophobia in individuals with PD. Results: Meta-analyses in neurological and musculoskeletal populations demonstrate moderate to large reductions in kinesiophobia following VR interventions, although effects vary depending on assessment tools, degree of immersion, and exposure design. In PD, VR has been applied to rehabilitation, anxiety reduction, and quality of life enhancement. These interventions achieved high adherence (≥90%), were well tolerated, and reported no major adverse events. Conclusions: Kinesiophobia is prevalent in PD and could contribute to physical inactivity. E-IVR appears feasible, safe, and innovative for addressing kinesiophobia in people living with PD.

Emotions play an undeniable role in addictive disorders. Given the high relapse and drop-out rates still prevalent in current treatments, it is crucial to explore curative alternatives that take greater account of emotions. The primary objective of this systematic review is to gather literature related to emotion regulation in psychological addictive disorders treatments. The aim is to describe its use for individuals with behavioral (such as gambling disorder, problematic Internet gaming, and Internet addiction) or substance-related disorders. Following a screening of nearly 12,000 articles from six databases and the grey literature, 38 studies that met the selection criteria were included. The results show that 63.2

Most individuals experience at least one traumatic event during their lifetime, which can lead to the development of psychopathological symptoms and Post-Traumatic Stress Disorder (PTSD). First responders (e.g., police officers, firefighters, emergency medical professionals) are exposed to traumatic events daily, making them particularly vulnerable to developing such symptoms. Using an online questionnaire, this study aimed to compare self-reported exposure to traumatic events and the presence of psychopathological and PTSD symptoms between a sample from the general community (n = 137) and first responders (n = 672) residing in Portugal. We also sought to identify factors associated with the development of PTSD symptoms. Results showed that although first responders reported higher exposure to traumatic events, there were no significant differences in PTSD symptoms between first responders and the general community. However, general psychopathological symptoms, particularly anxiety and depression, were higher in the general community than among first responders. Symptoms of anxiety, depression, obsessive-compulsive tendencies, hostility, paranoid ideation, psychoticism, and personally experienced traumatic events emerged as significant predictors of PTSD symptoms, whereas demographic variables showed no significant predictive value. The potential influence of factors such as terror management theory, training and education, professional selection, the "hero lifestyle", and the "police culture" is discussed, along with implications and directions for future research.

Background/Objectives: The aim was to identify patterns of autonomic and neuroendocrine reactivity to an immersive virtual reality (VR) social-emotional stressor and explore their associations with perceived stress and eating behavior. Methods: This one-group pretest–posttest study included 30 children and adolescents with obesity (15 boys and 15 girls), aged 8 to 17 years. The VR protocol consisted of two consecutive phases: a 5 min relaxation phase using the Forest application and a 5 min stimulation phase using a cognitively engaging VR game designed to elicit social-emotional stress. Physiological responses were measured using heart rate variability (HRV) indices and salivary stress biomarkers, including cortisol and alpha amylase. Subjective stress and eating responses were assessed via visual analogue scales (VAS) administered immediately post-exposure. The Three-Factor Eating Questionnaire (TFEQ-R21C) was used to evaluate cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE). Results: The cortisol reactivity was blunted and may reflect both the attenuated HPA axis responsiveness characteristic of pediatric obesity and the moderate psychological challenge of the VR stressor used in this study. Two distinct autonomic response patterns were identified via exploratory factor analysis: (1) parasympathetic reactivity, associated with increased RMSSD and SDNN and decreased LF/HF, and (2) sympathetic activation, associated with increased heart rate and alpha-amylase levels and reduced RR intervals. Parasympathetic reactivity was correlated with lower perceived stress and anxiety, but also paradoxically with higher uncontrolled eating (UE). In contrast, sympathetic activation was associated with greater cognitive restraint (CR) and higher anxiety ratings. Conclusions: This study demonstrates that immersive VR game exposure elicits measurable autonomic and subjective stress responses in children and adolescents with obesity, and that individual differences in physiological reactivity are relevantly associated with eating behavior traits. The findings suggest that parasympathetic and sympathetic profiles may represent distinct behavioral patterns with implications for targeted intervention.

INTRODUCTION:Individuals living with obesity often experience body image (BI) disturbances, which can negatively affect their quality of life and treatment outcomes. Virtual reality (VR) has emerged as a promising tool for enhancing psychological interventions, but no comprehensive review has specifically focused on VR-based studies addressing BI disturbances in this population. METHODS:This comprehensive review examined studies utilizing VR for the assessment and treatment of BI disturbances in individuals with obesity. Twelve studies met the inclusion criteria. RESULTS:Studies were categorized into three groups: (i) VR in psychological interventions for individuals with obesity, (ii) VR interventions following metabolic and bariatric surgery, and (iii) VR-based full-body illusion experiments. The primary clinical application was experiential cognitive therapy, which demonstrated greater efficacy in reducing negative BI compared with standard cognitive behavioral therapy and other treatments. Studies involving post-metabolic and bariatric surgery adults also supported VR's efficacy in reducing BI dissatisfaction, though long-term benefits were inconsistent. Full-body illusion experiments suggested that VR can help modify distorted body perceptions. However, most studies were conducted by the same research group, focused exclusively on women, and were limited to specific geographical regions, primarily Italy. CONCLUSION:While preliminary results suggest that VR is a promising tool for treating BI disturbances in individuals with obesity, the field remains under-researched. Notably, no studies have explored VR's potential as an assessment tool in this population. Future studies should include more diverse populations, investigate long-term outcomes, and explore potential barriers to clinical implementation.

As virtual reality (VR) technologies become more immersive and metaverse applications burgeon, modern headsets are increasingly becoming equipped with sensors capable of capturing multiple neurophysiological signals. While these signals can be used to measure, in real-time, quality of experience metrics that can be used to enhance interactivity and user engagement, they may also introduce novel privacy risks by unintentionally leaking sensitive personal attributes. In this paper, we explore the extent in which electroencephalography (EEG) signals, recorded during an immersive VR memory task, can be used to infer users’ private information, such as age, biological sex, and identity. We employ both classical machine learning models with hand-crafted features, as well as end-to-end deep learning approaches. Our findings demonstrate that EEG-based features can, indeed, leak information about biological sex, age, and user identity, with end-to-end models obtaining the best performance. Feature importance ranking and deep neural network saliency maps were used to provide explainability on the neural patterns used by the models. We conclude with recommendations on how these findings can also be used to help secure future metaverse applications.

BackgroundSocial anxiety disorder (SAD) has a high prevalence and an early onset. It often persists well into adulthood, turning into a chronic disorder. Cognitive behavioral therapy (CBT) is effective in treating SAD, but real-life exposure conducted as part of CBT is often costly and time-consuming, and imaginary exposure might lack realism and intensity. Virtual reality (VR)-based exposure using 360° video offers a promising way to deliver exposure therapy.ObjectiveTo develop a complete psychotherapeutic treatment program including CBT with VR-based exposure using 360° videos (CBT-ExpVR) for adult patients with SAD and to test the treatment effect using the Social Interaction Anxiety Scale (SIAS) as the primary outcome.MethodsThis three-arm randomized controlled trial involved 51 participants who were recruited through self-referral. The interventions took place at Center for Digital Psychiatry in Denmark. Participants were randomized via computer program to CBT-ExpVR, CBT with in vivo exposure (CBT-Exp), or an active control group offered VR relaxation (RlxVR). Afterwards, participants assigned to RlxVR were re-randomized to one of the two CBT interventions. Allocation was not blinded.ResultsIntention-to-treat analysis showed that participants receiving CBT-ExpVR reported significantly fewer symptoms of social anxiety at post-treatment compared to pre-treatment, β = −14.89, 95% CI (−18.64, −11.14), p < 0.0001. At post-treatment, no difference in treatment effect was found between CBT-ExpVR and CBT-Exp, β = 3.643, 95% CI (−1.727, 9.013), p = 0.1839. However, CBT-ExpVR was more effective than RlxVR, β = −11.537, 95% CI (−16.163, −6.911), p < 0.0001. Dropout rates post-treatment were 16% (CBT-ExpVR), 38% (CBT-Exp), and 20% (RlxVR). No harms were registered during the study.ConclusionCBT-ExpVR represents an effective treatment for SAD comparable to standard CBT treatment. CBT-ExpVR was reported as less costly and requiring less effort by the therapist compared to CBT-Exp. Thus, VR-based exposure might pave the way for a broader implementation of exposure in psychotherapeutic interventions for social anxiety by providing easy and low-cost access to exposure scenarios.Clinical Trials Registrationhttps://clinicaltrials.gov/study/NCT03973541, identifier NCT03973541.

Background/objectives: Several factors have been shown to play a role in the development and maintenance of generalized anxiety disorder (GAD), including intolerance of uncertainty and emotion dysregulation. Although the individual contribution of both of these factors is well documented, their combined effect has yet to be studied in a clinical population with GAD. The aim of the present study was to examine the relative contribution of intolerance of uncertainty and emotion dysregulation to the prediction of worry and GAD severity in adults with GAD. Methods: The sample consisted of 108 participants diagnosed with GAD. The participants completed measures of worry, GAD severity, depressive symptoms, intolerance of uncertainty, and emotion dysregulation. Results: Multiple regression indicated that both intolerance of uncertainty and emotion dysregulation significantly contributed to both worry and GAD severity, over and above the contribution of depressive symptoms. Of note, the model explained 36% of the variance in GAD severity scores. Conclusions: The present results provide preliminary evidence of complementarity among dominant models of GAD, and point to the potential role of integrative conceptualizations and treatment strategies for GAD.