Geänderte Inhalte

Etwa 40–50 Prozent der erwachsenen Bevölkerung nimmt aktuell an legalen oder illegalen Glücksspielangeboten in Deutschland teil (Zwölf-Monats-Prävalenz, Bundeszentrale für gesundheitliche Aufklärung, 2016; Meyer, 2016; Sassen et al., 2011). Beim überwiegenden Anteil bleibt es auf der Ebene einer problemlosen Unterhaltung, während etwa 0,3–0,6 Prozent der erwachsenen Bevölkerung oder etwa 0,8–1,0 Prozent der aktiven Spieler eine pathologische Ausprägung entwickelt (Bühringer, Kotter & Kräplin, 2016; Bundeszentrale für gesundheitliche Aufklärung, 2016; Meyer, 2016; Sassen et al., 2011). Neben Beratungs- und Behandlungsmaßnahmen bestehen in vielen Ländern Sperrsysteme, die Personen davon abhalten sollen, weiter an Glücksspielen teilzunehmen, um die negativen Konsequenzen wie emotionale Störungen, erhebliche Verschuldung, das Risiko des illegalen Erwerbs von finanziellen Mitteln sowie Probleme am Arbeitsplatz und in der Familie zu vermeiden bzw. zu reduzieren. Es gibt dabei unterschiedliche Ausprägungen von Sperrsystemen, z.B. im Hinblick auf die Begründung einer Sperre (Verschuldung und/oder pathologisches Spielverhalten), ihre Initiierung (Selbst- oder Fremdsperre), die Dauer (einige Monate bis Lebenszeit), den Geltungsbereich (ein oder mehrere Glücksspielsegmente) und die Möglichkeit und Modalitäten einer Entsperrung (für einen Überblick vergleiche Gainsbury, 2014). Für eine effektive Gestaltung von Sperrsystemen ist es notwendig, die Auswirkungen und die Einschätzung einer Sperrung durch betroffene Personen vor dem Hintergrund des Wissens aus den Verhaltenswissenschaften zu analysieren. Zumindest die Fremdsperre im Sinne eines Betretungs- und Spielverbots stellt einen erheblichen Eingriff in den Freiheitsspielraum einer Person dar. Es gibt wenige ähnliche Eingriffe, wie etwa rechtlich verfügte Näherungsverbote gegenüber früheren Partnern, Kindern oder Stalking-Opfern sowie Hausverbote in Kaufhäusern und Gaststätten (die Beispiele sind unabhängig davon, ob Betroffene oder Dritte geschützt werden sollen). Es ist daher zur Einhaltung einer Spielersperre notwendig, die betroffenen Personen möglichst gut über die Notwendigkeit und den Nutzen einer Sperre zu informieren und vor allem zur Einhaltung zu motivieren. Dies gilt auch dann, wenn viele selbst- oder fremdgesperrte Spieler zunächst die Sperre verbal akzeptieren, da die Akzeptanz eines Verbots bzw. der Wunsch oder das Verlangen nach erneutem Glücksspielen im Zeitverlauf variieren kann (Ladouceur, Sylvain & Gosselin, 2007).

Dieser Beitrag befasst sich mit der Frage, wie der Verbraucherschutz für Personen, die Glücksspielangebote in Deutschland terrestrisch oder online nutzen, möglichst effektiv umgesetzt werden kann. Hintergrund sind zum einen Forschungsergebnisse zu Entwicklung und Verlauf pathologischen Glücksspielens sowie zu den Zusammenhängen von Glücksspielangebot, Glücksspielmerkmalen und glücksspielbezogenen Störungen. Zudem wird die aktuelle Diskussion aufgrund verschiedener Gerichtsentscheidungen berücksichtigt, die zentrale Aspekte des gegenwärtigen Konzepts für den Verbraucherschutz in Deutschland infrage gestellt bzw. verworfen haben (vgl BeckOK GewO/Reeckmann, 33. Ed. 15.02.2016, GewO § 33i Rn. 6.1). In diesem Beitrag wird dafür plädiert, sehr viel stärker als bisher den Verbraucherschutz durch zwei miteinander verbundene Maßnahmen sicherzustellen: hohe Qualitätsanforderungen an Anbieter von Glücksspielen sowie hohe Qualitätskontrollen durch eine zentrale und unabhängige Regulierungsstelle. Verbraucherschutz wird dabei als übergeordneter Begriff für verschiedene Teilaspekte verstanden: Spielerschutz (vor allem die Prävention pathologischer Entwicklungen bzw. der Schutz von Personen, die bereits eine glücksspielbezogene Störung entwickelt haben), Jugendschutz (Verhinderung des Glückspielens durch Minderjährige), Vertragsrechtschutz (Einhaltung gesetzlicher Regelungen wie z. B. für Internetgeschäfte) und den Schutz vor Betrug und anderen illegalen Handlungen. Dies bedeutet auch, dass im Mittelpunkt des Beitrags die möglichst gute Sicherstellung eines risikoarmen Glücksspielens für alle erwachsenen Personen steht, die diese Angebote nutzen wollen, und nicht nur der Schutz für die Teilgruppe von Personen, die im Zusammenhang mit Glücksspielen ein pathologisches Spielverhalten entwickelt. Es bestehen unterschiedliche gesellschaftliche Wertvorstellungen, in welchem Umfang das Glückspielen in einer Gesellschaft zugelassen und reguliert werden soll (vgl. Forberger & Bühringer, 2014). Hierzu gibt es keine richtige oder falsche Antwort. Eine Entscheidung erfordert eine gesellschaftliche Diskussion, die sich letztlich in einer parlamentarischen Willensbildung ausdrückt, sowie in regelmäßigen Anpassungen aufgrund sich ändernder Wertvorstellungen und Glücksspielangebote. Diese Wertebasierung zeigt sich auch in sehr unterschiedlichen Regelungen in den Mitgliedsstaaten der Europäischen Union, von sehr liberal bis sehr restriktiv. Unabhängig von der gesellschaftlichen Diskussion und Entscheidung über das Angebot von Glücksspielen in einem Land gelten zumindest folgende Erkenntnisse: (1) Sehr extreme Einschränkungen bzw. eine komplette Prohibition führen zu Ausweichverhalten in illegale Angebote, (2) ein nicht oder wenig reguliertes Angebot führt ebenfalls zu negativen Konsequenzen, d. h. Verbraucherschutz ist notwendig und (3) es gibt kein Glücksspielangebot ohne problematische Entwicklungen des Spielverhaltens einzelner Personen. Es ist deshalb eine gemeinsame Verantwortung der Glücksspielanbieter, der Regulierungsstellen und auch der Glücksspieler selber, soweit sie Kontrolle über ihr Glücksspielverhalten haben, das Glücksspielangebot verantwortungsvoll zu steuern und zu nutzen und die Anzahl von Personen mit pathologischem Spielverhalten sowie dessen negative Auswirkungen möglichst gering zu halten.

Although it is often regarded as obvious, the exact nature of the relationship between gambling availability and gambling behaviour or disordered gambling remains unclear. However, disordered gambling is an important public health issue and restrictions on availability are seen as an important strategy to reduce gambling- related problems in many jurisdictions. Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we reviewed studies on the relationship between physical gambling availability and gambling behaviour, as well as disordered gambling, and focused on several currently discussed hypotheses about their relationship. We used a systematic electronic search strategy involving 12 search terms and several databases. We included 27 studies and evaluated them by applying a comprehensive quality rating and quality weighting of evidence. We found a high proportion of quality-weighted evidence for both a positive relationship (access hypothesis) and a decrease or plateau in the prevalence of gambling participation and disorders over time with increasing availability (adaptation hypothesis). However, several conceptual and methodological problems hamper final conclusions. For example, studies were often not based on precise hypotheses, only two studies had a longitudinal design, overall quality ratings varied widely, operationalizations of gambling availability were sometimes not objectively measured, follow-up periods were insufficient, and shifting behaviour was not assessed. To understand the causal role of gambling availability in the development and course of gambling disorder and to derive evidence-based prevention strategies, investigators need to perform more high-quality longitudinal research that is based on a solid theoretical framework with the corresponding statistical analyses.

Background: Mill’s liberalism, the post-World War II German Social Market Economy (Rhine Capitalism) and modern consumer protection share the conviction that market participants have equal rights and responsibilities. Within this framework, governments and market providers are responsible for balancing the knowledge deficits of consumers in cases of “asymmetric information”. The widely discussed Reno Model for Responsible Gambling appears to be based on similar ideas by setting standards for informing participants of gambling features and procedures. Position: Based on recent research, we argue that such standard consumer protection may be adequate for social gamblers but not for vulnerable gamblers. These individuals may not benefit adequately from a rational informed choice approach to prevent harm and disordered gambling. Conclusion: Gambling providers should implement specific protections to address vulnerable gamblers, e. g., early detection procedures and limits for or exclusion from gambling.

Efficient decoding of facial expressions and gaze direction supports reactions to social environments. Although both cues are processed fast and accurately, when and how these cues are integrated is still debated. We investigated the temporal integration of gaze and emotion cues. Participants responded to letters that were randomly presented on four faces. Two of these faces initially showed direct gaze, two showed averted gaze. Upon target presentation, two faces changed gaze direction (from averted to direct and vice versa). Simultaneously, facial expressions changed from neutral to either an approach- or an avoidance-oriented emotion expression (Experiment 1a: angry/fearful; Experiment 1b: happy/disgusted). Although angry and fearful expressions diminished any effects of gaze direction (Experiment 1a), a direct gaze advantage was found for happy and an averted gaze advantage for disgusted faces (Experiment 1b). This pattern is consistent with hypotheses suggesting a processing benefit when emotion expression and gaze information are congruent in terms of approach- or avoidance-orientation. In Experiment 2, we tracked eye movements and, again, found evidence for an approach–avoidance-congruency advantage for happy and disgusted faces both in performance and gaze behavior. Gaze behavior analyses suggested an integration of gaze and emotion information that was already visible from 300 ms after target onset. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

To estimate the effectiveness of gambling exclusion programmes, previous research focused on changes in gambling behaviour post-exclusion. Although other mental health problems, especially co-morbid mental disorders, may be crucial for relapse and recovery of gambling-related problems, these factors have rarely been studied in excluders. Therefore, this study aimed to assess a comprehensive mental health status of excluders using well-validated diagnostic instruments. Fifty-eight casino excluders participated in face-to-face diagnostic interviews and completed several validated questionnaires (e.g. Stinchfield Questionnaire, Brief Symptom Inventory). Retrospective temporal sequences of diagnosed mental disorders, help-seeking behaviour and exclusion were examined. The majority of excluders reported impairments in mental health aspects. About three-quarters met criteria of lifetime gambling disorder, more than half in the last 12 months whereby screening and diagnostic measures correlated moderately. Other mental disorders were frequent, especially affective and substance-related disorders and typically preceded the onset of gambling disorder. Six years passed between self-awareness of gambling problems and help-seeking. Two more years passed until exclusion. Frequent mental health problems suggest the need for individually tailored support beyond exclusion programmes (e.g. psychotherapy, pharmacotherapy, counselling services). Late help-seeking and exclusion entry claim for improved early detection and intervention concepts that consider underlying mental disorders.

Exposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions.

Anxiety disorders are the most common mental disorders and are often chronic and disabling. Although exposure-based treatments are effective, a substantial number of individuals fail to fully remit or experience a return of symptoms after treatment. Understanding the critical processes underlying the development and treatment of anxiety disorders will help identify individuals at risk and optimize treatments. Aversive associative learning offers explanatory pathways through which fear and anxiety emerge, spread, persist, and resurge. This narrative review examines the advances made in our understanding of associative fear and avoidance learning in anxiety disorders. Overall, the extant literature supports a key role of aversive associative learning in the development and treatment of anxiety disorders. However, research targeting specific mechanisms such as extinction generalization and avoidance, the fragility of extinction, and moderating influences of individual differences pertinent to anxiety disorders (e.g., age, sex, depression) is needed. We discuss the need for more ecological valid and complex paradigms to model ambiguity and conflict as well as for clinical translation studies to optimize treatment.

Purpose Of Review: Extinction learning is a major mechanism for fear reduction by means of exposure. Current research targets innovative strategies to enhance fear extinction and thereby optimize exposure-based treatments for anxiety disorders. This selective review updates novel behavioral strategies that may provide cutting-edge clinical implications. Recent Findings: Recent studies provide further support for two types of enhancement strategies. Procedural enhancement strategies implemented during extinction training translate to how exposure exercises may be conducted to optimize fear extinction. These strategies mostly focus on a maximized violation of dysfunctional threat expectancies and on reducing context and stimulus specificity of extinction learning. Flanking enhancement strategies target periods before and after extinction training and inform optimal preparation and post-processing of exposure exercises. These flanking strategies focus on the enhancement of learning in general, memory (re-)consolidation, and memory retrieval. Summary: Behavioral strategies to enhance fear extinction may provide powerful clinical applications to further maximize the efficacy of exposure-based interventions. However, future replications, mechanistic examinations, and translational studies are warranted to verify long-term effects and naturalistic utility. Future directions also comprise the interplay of optimized fear extinction with (avoidance) behavior and motivational antecedents of exposure.

It is hypothesized that the ability to discriminate between threat and safety is impaired in individuals with high dispositional negativity, resulting in maladaptive behavior. A large body of research investigated differential learning during fear conditioning and extinction protocols depending on individual differences in intolerance of uncertainty (IU) and trait anxiety (TA), two closely-related dimensions of dispositional negativity, with heterogenous results. These might be due to varying degrees of induced threat/safety uncertainty. Here, we compared two groups with high vs. low IU/TA during periods of low (instructed fear acquisition) and high levels of uncertainty (delayed non-instructed extinction training and reinstatement). Dependent variables comprised subjective (US expectancy, valence, arousal), psychophysiological (skin conductance response, SCR, and startle blink), and neural (fMRI BOLD) measures of threat responding. During fear acquisition, we found strong threat/safety discrimination for both groups. During early extinction (high uncertainty), the low IU/TA group showed an increased physiological response to the safety signal, resulting in a lack of CS discrimination. In contrast, the high IU/TA group showed strong initial threat/safety discrimination in physiology, lacking discriminative learning on startle, and reduced neural activation in regions linked to threat/safety processing throughout extinction training indicating sustained but non-adaptive and rigid responding. Similar neural patterns were found after the reinstatement test. Taken together, we provide evidence that high dispositional negativity, as indicated here by IU and TA, is associated with greater responding to threat cues during the beginning of delayed extinction, and, thus, demonstrates altered learning patterns under changing environments.

Background and Objectives: The reduction of avoidance behavior is a central target in the treatment of anxiety disorders, but it has rarely been studied how approach of fear-relevant stimuli may be initiated. In two studies, the impact of hypothetical monetary and symbolic social incentives on approach-avoidance behavior was examined.Methods: In Study 1, individuals high or low on fear of spiders (N = 84) could choose to approach a fear-relevant versus a neutral stimulus, which were equally rewarded. In a subsequent micro-intervention, approaching the fear-relevant stimulus was differentially rewarded either by monetary or social incentives. In Study 2 (N = 76), initial incentives for approach were discontinued to investigate the stability of approach. Results: Hypothetical monetary and symbolic social incentives reduced or eliminated initial avoidance, even in highly fearful individuals. Approach resulted in a decrease of self-reported aversiveness towards the fear-relevant stimulus. However, even after successful approach, fearful individuals showed significant avoidance behavior when incentives for approach were discontinued. Limitations: Future research should investigate the long-term effects of prolonged approach incentives on multiple levels of fear (e.g., self-report, behavioral, physiological). It should also be tested if such an intervention actually improves compliance with exposure based interventions. Conclusions: The present findings highlight that incentives are useful to initiate initial approach towards a feared stimulus. Although incentive-based approach may neither fully eliminate avoidance nor negative feelings towards the feared stimulus, such operant interventions may set the stage for more extensive extinction training.

Rewards for approaching a feared stimulus may compete with fear reduction inherent to avoidance and thereby alter fear and avoidance learning. However, the impact of such competing rewards on fear and avoidance acquisition has rarely been investigated. During acquisition, participants chose between one option (CS+ option) associated with a neutral stimulus followed by an aversive unconditioned stimulus (US) and another option (CS− option) associated with another neutral stimulus followed by no US (N = 223 randomized into three groups). In a subsequent test, no more USs occurred. In one group, competing rewards were established by linking the CS+ option to high rewards and the CS− option to low rewards during acquisition and test (Reward Group). In a second group, rewards were present during acquisition, but discontinued during test (Initial-Reward Group). In a third group, rewards were completely absent (No-Reward Group). Without competing rewards, significant avoidance was acquired and persisted in the absence of the US. Competing rewards attenuated avoidance acquisition already after the first experience of the aversive US. Avoidance remained attenuated even when rewards were discontinued during test. Rewards did, however, not change the level of fear responses to the CS+ (US expectancy, skin conductance). Finally, rewards did not change the level of fear reduction during test, which was, however, experienced earlier. Summarized, rewards for approaching aversive events do not buffer fear acquisition, but can prevent avoidance. This damping of avoidance may initiate fear extinction.

Symptoms of depersonalization during feared social situations are commonly experienced by individuals with social anxiety disorder (SAD). Despite its clinical relevance, it is not addressed in standard treatment manuals and it remains unclear if depersonalization is reduced by well-established treatments. This study investigated whether cognitive therapy (CT) for SAD effectively reduces depersonalization and whether pre-treatment severity of depersonalization predicts or mediates treatment outcome. In a randomized controlled trial, patients underwent the standardized Trier Social Stress Test before and after CT (n = 20) or a waitlist period (n = 20) and were compared to healthy controls (n = 21). Self-reported depersonalization was measured immediately after each stress test. Depersonalization significantly decreased following CT, especially in treatment responders (ηp2 = 0.32). Pre-treatment depersonalization did neither predict nor mediate post-treatment severity of social anxiety. Further prospective studies are needed for a better scientific understanding of this effect. It should be scrutinized whether SAD-patients suffering from depersonalization would benefit from a more specific therapy.

Background and Objectives: Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) have both garnered empirical support for the effective treatment of social anxiety disorder. However, not every patient benefits equally from either treatment. Identifying moderators of treatment outcome can help to better understand which treatment is best suited for a particular patient. Methods: Forty-nine individuals who met criteria for social anxiety disorder were assessed as part of a randomized controlled trial comparing 12 weeks of CBT and ACT. Pre-treatment avoidance of social situations (measured via a public speaking task and clinician rating) was investigated as a moderator of post-treatment, 6-month follow-up, and 12-month follow-up social anxiety symptoms, stress reactivity, and quality of life. Results: Public speaking avoidance was found to be a robust moderator of outcome measures, with more avoidant individuals generally benefitting more from CBT than ACT by 12-month follow-up. In contrast, clinician-rated social avoidance was not found to be a significant moderator of any outcome measure. Limitations: Results were found only at 12-month follow-up. More comprehensive measures of avoidance would be useful for the field moving forward. Conclusions: Findings inform personalized medicine, suggesting that social avoidance measured behaviorally via a public speaking task may be a more robust factor in treatment prescription compared to clinician-rated social avoidance.

Background and objectives: Identifying for whom and under what conditions a treatment is most effective is an essential step toward personalized medicine. The current study examined pre-treatment physiological and behavioral variables as predictors and moderators of outcome in a randomized clinical trial comparing cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety disorders. Methods: Sixty individuals with a DSM-IV defined principal anxiety disorder completed 12 sessions of either CBT or ACT. Baseline physiological and behavioral variables were measured prior to entering treatment. Self-reported anxiety symptoms were assessed at pre-treatment, post-treatment, and 6- and 12-month follow-up from baseline. Results: Higher pre-treatment heart rate variability was associated with worse outcome across ACT and CBT. ACT outperformed CBT for individuals with high behavioral avoidance. Subjective anxiety levels during laboratory tasks did not predict or moderate treatment outcome. Limitations: Due to small sample sizes of each disorder, disorder-specific predictors were not tested. Future research should examine these predictors in larger samples and across other outcome variables. Conclusions: Lower heart rate variability was identified as a prognostic indicator of overall outcome, whereas high behavioral avoidance was identified as a prescriptive indicator of superior outcome from ACT versus CBT. Investigation of pre-treatment physiological and behavioral variables as predictors and moderators of outcome may help guide future treatment-matching efforts.

Objective: Cognitive behavioral therapy (CBT) has been well established in the treatment of posttraumatic stress disorder (PTSD). In recent years, researchers have begun to investigate its underlying mechanisms of change. Dysfunctional cognitive content, i.e. excessively negative appraisals of the trauma or its consequences, has been shown to predict changes in PTSD symptoms over the course of treatment. However, the role of change in cognitive processes, such as trauma-related rumination, needs to be addressed. The present study investigates whether changes in rumination intensity precede and predict changes in symptom severity. We also explored the extent to which symptom severity predicts rumination. Method: As part of a naturalistic effectiveness study evaluating CBT for PTSD in routine clinical care, eighty-eight patients with PTSD completed weekly measures of rumination and symptom severity. Lagged associations between rumination and symptoms in the following week were examined using linear mixed models. Results: Over the course of therapy, both ruminative thinking and PTSD symptoms decreased. Rumination was a significant predictor of PTSD symptoms in the following week, although this effect was at least partly explained by the time factor (e.g., natural recovery or inseparable treatment effects). Symptom severity predicted ruminative thinking in the following week even with time as an additional predictor. Conclusions: The present study provides preliminary evidence that rumination in PTSD is reduced by CBT for PTSD but does not give conclusive evidence that rumination is a mechanism of change in trauma-focused treatment for PTSD.

Objective: This study examined the effectiveness of manualized cognitive therapy (mCT) following the Clark-Wells approach versus non-manualized cognitive-behavioral treatment-as-usual (CBTAU) for social anxiety disorder (SAD) in routine practice. Methods: Forty-eight private practitioners were recruited within a multi-center trial and either received training in manualized CT for SAD or no such training. Practitioners treated 162 patients with SAD in routine practice (N = 107 completers, n = 57 for mCT, n = 50 for CBTAU). Social anxiety symptoms (Liebowitz Social Anxiety Scale; LSAS) and secondary measures were assessed before treatment, at treatment-hour 8, 15, and 25, at end of treatment, as well as 6 and 12 months after treatment. Results: Patients in both groups showed significant reductions of SAD severity after treatment (d = 1.91 [mCT] and d = 1.80 [CBTAU], within-group effect sizes, intent-to-treat analyses, LSAS observer ratings), which remained stable at follow-up. There were no differences between groups in terms of symptom reduction and treatment duration. Conclusions: The present trial confirms the high effectiveness of CBTAU and mCT for SAD when practitioners conduct the treatments in routine practice. Additional training in the CT manual did not result in significant between-group effects on therapy outcome. Explanations for this unexpected result are discussed.

Anxiety can boost the detection of potential threats in many ways. There is evidence that one and the same facial expression can be perceived differently depending on whether it is seen in a neutral or in a threatening situation. The present study investigated how aversive anticipation influences the accuracy of facial emotion recognition and the perceived emotional intensity of faces that had their objective emotional intensity manipulated. Forty-three participants categorized and rated the intensity of morphed faces (20%, 40%, 60%, and 80%) of fearful, angry, and happy expressions. Differently colored picture frames indicated either threat of electric shock or safety. Threat of shock enhanced the categorization accuracy specifically for fearful faces. During threat, 80% fearful and happy faces, and all levels of angry faces (20%–80%) were rated as more intense. In addition, we found that more trait-anxious individuals more frequently erroneously categorized neutral faces as fearful. Thus, state anxiety enhanced accurate fear categorization and boosted the perceived intensity of emotional faces, whereas trait anxiety led to a biased threat perception in nonthreatening faces. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

It remains unclear if diminished high frequency heart rate variability (HF-HRV) can be found across anxiety disorders. HF-HRV and heart rate (HR) were examined in panic (PD), generalized anxiety (GAD), social anxiety (SAD), and obsessive-compulsive disorder (OCD) relative to healthy controls at baseline and during anxiety stressors. All disorders evidenced diminished baseline HF-HRV relative to controls. Baseline HRV differences were maintained throughout relaxation. For hyperventilation, PD and GAD demonstrated greater HR than controls. Psychotropic medication did not account for HF-HRV differences except in OCD. Age and sex evidenced multiple main effects. Findings suggest that low baseline HF-HRV represents a common index for inhibitory deficits across PD, GAD, and SAD,which is consistent with the notion of autonomic inflexibility in anxiety disorders. Elevated HR responses to hyperventilation, however, are specific to PD and GAD. (PsycInfo Database Record (c) 2022 APA, all rights