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Journal of Psychopathology and Behavioral Assessment

Gepubliceerd in:

01-06-2025

The Role of Hypervigilance, Checking, and Avoidance Behaviours in the Diagnosis of Generalized Anxiety Disorder During the Perinatal Period

Auteurs: Briar E. Inness, Sheryl M. Green, Melissa Furtado, Bethany Easterbrook, David L. Streiner, Alyssa Georgescu, Randi E. McCabe

Gepubliceerd in: Journal of Psychopathology and Behavioral Assessment | Uitgave 2/2025

Abstract

Generalized anxiety disorder (GAD) is common during the perinatal period. Since its inception, substantial efforts have been put forth to improve the specificity and interrater reliability of GAD. More recently, increased attention has been given to the behavioral features of GAD, with evidence to suggest that hypervigilance, checking, and avoidance may be particularly relevant. It is unknown however if these behaviors lead to improved classification and understanding of GAD. The present study examines: (1) the proportion of perinatal individuals with and without GAD who endorse hypervigilance, checking and avoidance; (2) interrater reliability of GAD during the perinatal period; (3) whether inclusion of hypervigilance, checking, and avoidance in GAD diagnostic criteria leads to improved interrater reliability; and (4) if hypervigilance, checking and avoidance significantly predict GAD diagnostic status beyond current features of the disorder. Thirty-eight perinatal women, who were predominantly white and highly educated were randomized to one of two assessors to complete a semi-structured diagnostic assessment. Interviewers queried about the presence of current mental health disorders and engagement in behaviors of interest. Each assessment was independently rated by three assessors. More participants with GAD reported engaging in hypervigilance, checking, and avoidance than those without GAD. Interrater agreement of GAD diagnoses was excellent (κ = 0.91). Inter-rater agreement of GAD diagnoses was comparable (κ = 0.92) when checking was included in the diagnostic criteria of GAD. Checking also significantly predicted GAD diagnostic status beyond existing features of the disorder. These results support continued evaluation of the role of checking in GAD.

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Ali, E. (2018). Women’s experiences with postpartum anxiety disorders: A narrative literature review. International Journal of Women’s Health, 10, 237–249. https://doi.org/10.2147/IJWH.S158621CrossRefPubMedPubMedCentral

American Psychiatric Association (2022). Diagnostic and statistical manual of mental Disorders Text Revision (5^th ed. TR). https://doi.org/10.1176/appi.books.9780890425787

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

American Psychiatric Association (1987). Diagnostic and statistical manual of mental Disorders Text Revision (3rded. TR). https://doi.org/10.1176/appi.books.9780890420188.dsm-iii-r

Andrews, G., Hobbs, M. J., Borkovec, T. D., Beesdo, K., Craske, M. G., Heimberg, R. G., Rapee, R. M., Ruscio, A. M., & Stanley, M. A. (2010). Generalized worry disorder: A review of DSM-IV generalized anxiety disorder and options for DSM-V. Depression and Anxiety, 27(2), 134–147. https://doi.org/10.1002/da.20658CrossRefPubMed

Beesdo-Baum, K., Jenjahn, E., Höfler, M., Lueken, U., Becker, E. S., & Hoyer, J. (2012). Avoidance, safety behavior, and reassurance seeking in generalized anxiety disorder. Depression and Anxiety, 29(11), 948–957. https://doi.org/10.1002/da.21955CrossRefPubMed

Borkovec, T. D., & Newman, M. G. (1998). Worry and generalized anxiety disorder. Comprehensive Clinical Psychology, 6, 439–459. https://doi.org/10.1016/B0080-4270(73)00201–7CrossRef

Brown, T. A., & Tung, E. S. (2018). The contribution of worry behaviors to the diagnosis of generalized anxiety disorder. Journal of Psychopathology and Behavioral Assessment, 40(4), 636–644. https://doi.org/10.1007/s10862-018-9683-5CrossRefPubMedPubMedCentral

Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110(4), 585–599. https://doi.org/10.1037/0021-843X.110.4.585CrossRefPubMed

Chorpita, B. F., Brown, T. A., & Barlow, D. H. (1998). Perceived control as a mediator of family environment in etiological models of childhood anxiety. Behavior Therapy, 29(3), 457–476. https://doi.org/10.1016/s0005-7894(98)80043-9CrossRef

Cisler, J. M., & Koster, E. H. W. (2010). Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review. Clinical Psychology Review, 30(2), 203–216. https://doi.org/10.1016/j.cpr.2009.11.003CrossRefPubMed

Clark, K. D., Luong, S., Lunn, M. R., Flowers, E., Bahalkeh, E., Lubensky, M. E., Capriotti, M. R., Obedin-Maliver, J., & Flentje, A. (2022). Healthcare mistreatment, state-level policy. Protections, and healthcare avoidance among gender minority people. Sexuality Research and Social Policy, 19, 1717–1730. https://doi.org/10.1007/s13178-022-00748-1CrossRefPubMed

Coleman, S. L., Pietrefesa, A. S., Holaway, R. M., Coles, M. E., & Heimberg, R. G. (2011). Content and correlates of checking related to symptoms of obsessive compulsive disorder and generalized anxiety disorder. Journal of Anxiety Disorders, 25(2), 293–301. https://doi.org/10.1016/j.janxdis.2010.09.014CrossRefPubMed

Davey, G. C. L., Hampton, J., Farrell, J., & Davidson, S. (1992). Some characteristics of worrying: Evidence for worrying and anxiety as separate constructs. Personality and Individual Differences, 13(2), 133–147. https://doi.org/10.1016/0191-8869(92)90036-oCrossRef

Dennis, C. L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. The British Journal of Psychiatry, 210(5), 315–323. https://doi.org/10.1192/bjp.bp.116.187179CrossRefPubMed

Donegan, E., & Dugas, M. J. (2012). Generalized anxiety disorder: A comparison of symptom change in adults receiving cognitive-behavioral therapy or applied relaxation. Journal of Consulting and Clinical Psychology, 80, 490–496. https://doi.org/10.1037/a0028132CrossRefPubMed

Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205. https://doi.org/10.1521/ijct.2008.1.3.192CrossRef

Fleiss, J. L., Nee, J. C., & Landis, J. R. (1979). Large sample variance of kappa in the case of different sets of raters. Psychological Bulletin, 86(5), 974–977. https://doi.org/10.1037/0033-2909.86.5.974CrossRef

Goldfinger, C., Green, S. M., Furtado, M., & McCabe, R. E. (2019). Characterizing the nature of worry in a sample of perinatal women with generalized anxiety disorder. Clinical Psychology & Psychotherapy, 27(2), 136–145. https://doi.org/10.1002/cpp.2413CrossRef

Gordon, D., & Heimberg, R. G. (2011). Reliability and validity of DSM-IV generalized anxiety disorder features. Journal of Anxiety Disorders, 25(6), 813–821. https://doi.org/10.1016/j.janxdis.2011.04.001CrossRefPubMed

Green, S. M., Donegan, E., McCabe, R. E., Streiner, D. L., Furtado, M., Noble, L., Agako, A., & Frey, B. N. (2021). Cognitive behavior therapy for women with generalized anxiety disorder in the perinatal period: Impact on problematic behaviors. Behavior Therapy, 52, 907–916. https://doi.org/10.1016/j.beth.2020.11.004CrossRefPubMed

Hazlett-Stevens, H., Pruitt, L. D., & Collins, A. (2008). Phenomenology of generalized anxiety disorder. In M. M. Antony, & M. B. Stein (Eds.), Oxford handbook of anxiety and related disorders (pp. 1–15). Oxford University Press.

Holaway, R. M., Heimberg, R. G., & Coles, M. E. (2006). A comparison of intolerance of uncertainty in analogue obsessive-compulsive disorder and generalized anxiety disorder. Journal of Anxiety Disorders, 20(2), 158–174. https://doi.org/10.1016/j.janxdis.2005.01.002CrossRefPubMed

IBM Corp (2023). IBM SPSS statistics for Macintosh (Version 29.0) [Computer software]. https://www.ibm.com/products/spss-statistics

Inness, B. E., McCabe, R. E., & Green, S. M. (2022). Problematic behaviours associated with generalized anxiety disorder during pregnancy and the postpartum period: A thematic analysis. Psychology and Psychotherapy: Theory Research and Practice, 95(4), 921–938. https://doi.org/10.1111/papt.12410CrossRef

Inness, B. E., McCabe, R. E., Streiner, D. L., Barrett, E., & Green, S. M. (2023). The worry behaviors Inventory– perinatal revised: Adaptation and initial validation for use in perinatal samples. Assessment, 31(2), 350–362. https://doi.org/10.1177/10731911231165071CrossRefPubMedPubMedCentral

Kertz, S. J., Bigda-Peyton, J. S., Rosmarin, D. H., & Björgvinsson, T. (2012). The importance of worry across diagnostic presentations: Prevalence, severity and associated symptoms in a partial hospital setting. Journal of Anxiety Disorders, 26(1), 126–133. https://doi.org/10.1016/j.janxdis.2011.10.005CrossRefPubMed

Kirubarajan, A., Barker, L. C., Leung, S., Ross, L. E., Zaheer, J., Park, B., Abramovich, A., Yudin, M. H., & Lam, J. S. H (2022). LGBTQ2S + childbearing individuals and perinatal mental health: A systematic review. BJOG: an International Journal of Obstetrics and Gynaecology, 129(10), 1630–1643. https://doi.org/10.1111/1471-0528.17103CrossRefPubMed

Lawrence, A. E., & Brown, T. A. (2008). Classification and boundaries among anxiety-related problems. In M. M. Antony, & M. B. Stein (Eds.), Oxford handbook of anxiety and related disorders (pp. 265–276). Oxford University Press.

Lecrubier, Y., Sheehan, D. V., Weiller, E., Amorim, P., Bonora, I., Sheehan, K. H., Janavs, J., & Dunbar, G. C. (1997). The mini international neuropsychiatric interview (MINI). A short diagnostic structured interview: Reliability and validity according to the CIDI. European Psychiatry, 12(5), 224–231. https://doi.org/10.1016/S0924-9338(97)83296-8CrossRef

Liu, M., Patel, V. R., Sandhu, S., Reisner, S., & Keuroghlian, A. S. (2024). Health care discrimination and care avoidance due to patient-clinician identity discordance among sexual and gender minority adults. The Annals of Family Medicine, 22(4), 329–332. https://doi.org/10.1370/afm.3130CrossRefPubMed

Maas, C. J. M., & Fox, J. J. (2005). Sufficient sample sizes for multilevel modeling. Methodology: European Journal of Research Methods for the Behavioral and Social Sciences, 1(3), 86–92. https://doi.org/10.1027/1614-2241.1.3.86CrossRef

Mahoney, A. E. J., Hobbs, M. J., Newby, J. M., Williams, A. D., Sunderland, M., & Andrews, G. (2016). The worry behaviors inventory: Assessing the behavioral avoidance associated with generalized anxiety disorder. Journal of Affective Disorders, 203, 256–264. https://doi.org/10.1016/j.jad.2016.06.020CrossRefPubMed

Mahoney, A. E. J., Hobbs, M. J., Williams, A. D., Andrews, G., & Newby, J. M. (2018a). The mediating relationship between maladaptive behaviours, cognitive factors, and generalized anxiety disorder symptoms. Behaviour Change, 35, 123–138. https://doi.org/10.1017/bec.2018.13CrossRef

Mahoney, A. E. J., Hobbs, M. J., Newby, J. M., Williams, A. D., & Andrews, G. (2018b). Maladaptive behaviours associated with generalized anxiety disorder: An item response theory analysis. Behavioural and Cognitive Psychotherapy, 46, 479–496. https://doi.org/10.1017/S1352465818000127CrossRefPubMed

McHugh, M. L. (2012). Interrater reliability: The kappa statistic. Biochemia Medica, 22(3), 276–282. PMID: 23092060.CrossRefPubMedPubMedCentral

Miller, M. L., Dupree, J., Monette, M. A., Lau, E. K., & Peipert, A. (2024). Health equity and perinatal mental health. Current Psychiatry Reports, 26, 460–469. https://doi.org/10.1007/s11920-024-01521-4CrossRefPubMed

Newman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., & Cashman- McGrath, L. (2002). Preliminary reliability and validity of the generalized anxiety disorder questionnaire-IV: A revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33(2), 215–233. https://doi.org/10.1016/S0005-7894(02)80026-0CrossRef

Newman, M. G., Llera, S. J., Erickson, T. M., Przeworski, A., & Castonguay, L. G. (2013). Worry and generalized anxiety disorder: A review and theoretical synthesis of evidence on nature, etiology, mechanisms, and treatment. Annual Reviews in Clinical Psychology, 9, 275–297. https://doi.org/10.1146/annurev-clinpsy-050212-185544CrossRef

Newman, M. G., Zainal, N. H., & Hoyer, J. (2020). Congnitive-behavioural therapy (CBT) for generalized anxiety disorder (GAD). In A. L. Gerlach, & A. T. Gloster (Eds.), Generalized anxiety disorder and worrying: A comprehensive handbook for clinicians and researchers. John Wiley & Sons Ltd.

Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. The Psychiatric Clinics of North America, 33(3), 557–577. https://doi.org/10.1016/j.psc.2010.04.002CrossRefPubMed

Pelletier, L., O’Donnell, S., McRae, L., & Grenier, J. (2017). The burden of generalized anxiety disorder in Canada. Health Promotion and Chronic Disease Prevention in Canada: Research Policy and Practice, 37(2), 54–62. https://doi.org/10.24095/hpcdp.37.2.04CrossRefPubMed

Pergamin-Hight, L., Naim, R., Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., & Bar-Haim, Y. (2015). Content specificity of attention bias to threat in anxiety disorders: A meta-analysis. Clinical Psychology Review, 35, 10–18. https://doi.org/10.1016/j.cpr.2014.10.005CrossRefPubMed

Pierson, M. E., Prenoveau, J. M., Craske, M. G., Netsi, E., & Stein, A. (2017). Psychometric properties of the generalized anxiety disorder Questionnaire–IV (GAD-Q-IV) in postpartum mothers. Psychological Assessment, 29(11), 1391–1399. https://doi.org/10.1037/pas0000443CrossRefPubMedPubMedCentral

Robichaud, M. (2013). Cognitive behavior therapy targeting intolerance of uncertainty: Application to a clinical case of generalized anxiety disorder. Cognitive and Behavioral Practice, 20(3), 251–263. https://doi.org/10.1016/j.cbpra.2012.09.001CrossRef

Robichaud, M., Koerner, N., & Dugas, M. J. (2019). Cognitive behavioral treatment for generalized anxiety disorder: From science to practice. Routledge.

Rodebaugh, T. L., Holaway, R. M., & Heimberg, R. G. (2008). The factor structure and dimensional scoring of the generalized anxiety disorder questionnaire for DSM-IV. Sage Journals, 15(3), 343–350. https://doi.org/10.1177/1073191107312547CrossRef

Ruscio, A. M. (2002). Delimiting the boundaries of generalized anxiety disorder: Differentiating high Worriers with and without GAD. Journal of Anxiety Disorders, 16(4), 377–400. https://doi.org/10.1016/s0887-6185(02)00130-5CrossRefPubMed

Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2008). The epidemiology of obsessive-compulsive disorder in the National comorbidity survey replication. Molecular Psychiatry, 15(1), 53–63. https://doi.org/10.1038/mp.2008.94CrossRefPubMedPubMedCentral

Rutter, L. A., & Brown, T. A. (2015). Reliability and validity of the dimensional features of generalized anxiety disorder. Journal of Anxiety Disorders, 29, 1–6. https://doi.org/10.1016/j.janxdis.2014.10.003CrossRefPubMed

Schut, A. J., Castonguay, L. G., & Borkovec, T. D. (2001). Compulsive checking behaviors in generalized anxiety disorder. Journal of Clinical Psychology, 57(6), 705–715. https://doi.org/10.1002/jclp.1043CrossRefPubMed

Sheehan, M., & Dunbar, G. (1997). The validity of the mini international neuropsychiatric interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12(5), 232–241. https://doi.org/10.1016/S0924-9338(97)83297-XCrossRef

Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. C. (1998). The Mini-International neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59(Suppl 20), 22–33.PubMed

Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. B. (1990). Structured clinical interview for the DSM-III-R. American Psychiatric.

Starcevic, V., & Portman, M. E. (2013). The status quo as a good outcome: How the DSM-5 diagnostic criteria for generalized anxiety disorder remained unchanged from the DSM-IV criteria. Australian & New Zealand Journal of Psychiatry, 47(11), 995–997. https://doi.org/10.1177/0004867413503719CrossRef

Starcevic, V., Portman, M. E., & Beck, A. T. (2012). Generalized anxiety disorder: Between neglect and an epidemic. The Journal of Nervous and Mental Disease, 200(8), 664–667. https://doi.org/10.1097/NMD.0b013e318263f947CrossRefPubMed

Stein, A., Craske, M. G., Lehtonen, A., Harvey, A., Savage-McGlynn, E., Davies, B., Goodwin, J., Murray, L., Cortina-Borja, M., & Counsell, N. (2012). Maternal cognitions and mother-infant interaction in postnatal depression and generalized anxiety disorder. Journal of Abnormal Psychology, 121(4), 795–809. https://doi.org/10.1037/a0026847CrossRefPubMedPubMedCentral

Tallis, F., & de Silva, P. (1992). Worry and obsessional symptoms: A correlational analysis. Behaviour Research and Therapy, 30(2), 103–105. https://doi.org/10.1016/0005-7967(92)90132-zCrossRefPubMed

Townsend, M. H., Weissbecker, K. A., & Barbee, J. G. (1999). Compulsive behavior in generalized anxiety disorder and obsessive-compulsive disorder. Journal of Nervous and Mental Diseases, 187, 697–699.CrossRef

Weisberg, R. B. (2009). Overview of generalized anxiety disorder: Epidemiology, presentation, and course. The Journal of Clinical Psychiatry, 70(Suppl 2), 4–9. PMID: 19371500.CrossRefPubMed

Wichstrøm, L., Penelo, E., Rensvik Viddal, K., de la Osa, N., & Ezpeleta, L. (2018). Explaining the relationship between temperament and symptoms of psychiatric disorders from preschool to middle childhood: Hybrid fixed and random effects models of Norwegian and Spanish children. Journal of Child Psychology and Psychiatry, 59(3), 285–295. https://doi.org/10.1111/jcpp.12772CrossRefPubMed

Wittchen, H. U. (2002). Generalized anxiety disorder: Prevalence, burden, and cost to society. Depression and Anxiety, 16(4), 162–171. https://doi.org/10.1002/da.10065CrossRefPubMed

Woody, S., & Rachman, S. (1994). Generalized anxiety disorder (GAD) as an unsuccessful search for safety. Clinical Psychology Review, 14(8), 743–753. https://doi.org/10.1016/0272-7358(94)90040-xCrossRef

Zanarini, M. C., Skodol, A. E., Bender, D., Dolan, R., Sanislow, C., Schaefer, E., Morey, L. C., Grilo, C. M., Shea, M. T., McGlashan, T. H., & Gunderson, J. G. (2000). The collaborative longitudinal personality disorders study: Reliability of axis I and II diagnoses. Journal of Personality Disorders, 14(4), 291–299. https://doi.org/10.1521/pedi.2000.14.4.291CrossRefPubMed

Titel: The Role of Hypervigilance, Checking, and Avoidance Behaviours in the Diagnosis of Generalized Anxiety Disorder During the Perinatal Period
Auteurs: Briar E. Inness
Sheryl M. Green
Melissa Furtado
Bethany Easterbrook
David L. Streiner
Alyssa Georgescu
Randi E. McCabe
Publicatiedatum: 01-06-2025
Uitgeverij: Springer US
Gepubliceerd in: Journal of Psychopathology and Behavioral Assessment / Uitgave 2/2025
Print ISSN: 0882-2689
Elektronisch ISSN: 1573-3505
DOI: https://doi.org/10.1007/s10862-025-10210-2

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The Role of Hypervigilance, Checking, and Avoidance Behaviours in the Diagnosis of Generalized Anxiety Disorder During the Perinatal Period

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