The Characteristics Of Symptoms And Cognitions For Generalized Anxiety Disorder In Young Males: A Network Analysis

BackgroundGeneralized anxiety disorder(GAD)is a chronic mental disorder characterized by excessive worry(WO)and accompanied by other psychological and physical symptoms.In recent years,the emerging network theory holds that mental disorders arise from direct interactions between symptoms.This theory is different from the traditional theory of common cause of mental disorders.It does not assume that the co-occurrence of symptoms is due to the underlying entity,but regards mental disorders as a complex condition composed of strongly connected symptoms network.The rapid development of the network theory of mental disorders has gained widespread attention and recognition,and promoted symptoms as the main candidate for intervention.Therefore,exploring the dynamic relationship between GAD symptoms is important for us to understand the occurrence and development of GAD and to implement more accurate and effective interventions.The three cognitive models proposed recently provide unique and profound perspectives for the theoretical constructions and treatments of GAD.These cognitive models suggest that meta-worry(MW),intolerance of uncertainty(IU)and attention bias towards threat(AB)are the core cognitive factors for the development and maintenance of GAD respectively(especially the core symptom WO).This has resulted in the emergence of psychological interventions that focus on these core cognitive factors.However,the efficacy of existing psychological interventions is still limited.An in-depth understanding of the complex relationship between core symptom of GAD and related cognitive factors may be an effective breakthrough point for improving the efficacy of psychological interventions.Currently,we know little about the complex relationship characteristics of symptoms and cognitions of GAD.(1)The dynamic relationship between symptoms of GAD has not been reported.(2)The complex relationship between core symptom and related cognitive factors of GAD remains to be further explored.Network analysis(NA)based on network theory and NA combined with experiment sampling methods(ESM)have unique methodological advantages in mathematical analysis and visual expression of complex relationship(partial correlation and time causality)of multivariable systems and in evaluating centrality degree of variables.Therefore,this study uses NA and ESM to explore the complex relationship between symptoms and cognitions in young males with GAD from a group level,so as to provide new perspectives and ideas for prevention,evaluation and intervention.MethodsGeneralized anxiety disorder 7-item questionnaire(GAD-7)was used to screen young males with elevated scores(GAD-7 ≥ 10)and no history of any mental disorder.Study 1 included 60 participants and study 2 included 122 participants.Study 1: Using the complete Diagnostic criteria for GAD symptoms(8 items in total)in the Diagnostic and Statistical Manual of Mental Disorders(Fifth Edition,DSM-5)to assess participants’ GAD symptoms for 50 days.Running R-package ml VAR and qgraph to calculate and visualize temporal network(TN),contemporaneous network(CN),and between-subjects network(BN)of these symptoms.We were particularly interested in the out-strength(OS)and in-strength(IS)of each symptom in TN and the strength centrality(SC)of each symptom in CN and BN.Study 2: Using the Penn State Worry Questionnaire(PSWQ),Meta-worry Questionnaire(MWQ),12-item Intolerance of Uncertainty Scale(IUS-12),and dot-probe task(DPT)to measure worry(core symptom of GAD)and related cognitive factors(MW,IU,AB)respectively of participants.The regularized partial correlation network(RPCN)between core symptom and cognitive factors was calculated and visualized by R-package qgraph,mgm,and bootnet in software R.We were particularly interested in the expected influence(EI)and predictability of each variable in RPCN.ResultsStudy 1: In TNs,the associations between symptoms were strong,and all associations were positive."Sleep disturbance","muscle tension" and "excessive anxiety and worry" showed the highest OS in the two TNs respectively,while "difficult to control the worry" and "being easily fatigued" showed the highest IS in the two TNs respectively.Each symptom showed autocorrelation and the autocorrelation effects of more than half of the symptoms were stronger than the cross-lagged effects.In addition,some interesting feedback loops appeared in the network,such as "restlessness or feeling keyed up or on edge" predicted "being easily fatigued","being easily fatigued" predicted "difficulty concentrating or mind going blank","difficulty concentrating or mind going blank" in turn predicted "restlessness or feeling keyed up or on edge";In CNs,the associations between symptoms were strong,and all associations were positive."Difficult to control the worry","restlessness or feeling keyed up or on edge" and "excessive anxiety and worry" showed the highest SC in both two CNs,while "sleep disturbance" showed the lowest SC in both two CNs.In BNs,the associations between symptoms were close,and all associations were positive."Difficult to control the worry","restlessness or feeling keyed up or on edge" and "difficulty concentrating or mind going blank" showed the highest SC in both two BNs,while "sleep problems" showed the lowest SC in both two BNs.Study 2: In RPCN,we determined the network structure and the EI and predictability of each variable.Each variable had associations with the others.The regularized partial correlation between WO and MW,WO and IU,MW and IU,MW and AB,AB and WO and AB and IU was 0.41,0.31,0.22,0.11,-0.04 and-0.12 respectively.MW and WO had the highest EI and predictability,while AB had the lowest EI and predictability.In addition,the accuracy of the edge-weights and the stability of the centrality index in RPCN were both high,and the correlation stability(CS)coefficient was 0.52.ConclusionStudy 1: This study for the first time combines NA and ESM to explore the DSM-5-based dynamic network of GAD symptoms in young males.The current study identified the central role of "sleep disturbance","muscle tension," and "excessive anxiety and worry" in the whole GAD symptoms group,especially the key effect of "sleep disturbance" on all other symptoms,and "excessive anxiety and worry" on "sleep disturbance".This suggests that direct interventions of these core symptoms should be more effective in reducing the severity of all other symptoms within the network.Study 2: This study for the first time uses NA to explore the complex relationship between core symptoms and relative cognitions of GAD in young males.Specifically,the study found that MW and MO had the highest centrality and predictability in the whole network.This suggests that targeting MW and WO may lead to general benefits in the rest of the other factors considered in the network.In addition,we believe that integrating different psychological interventions which targeted at WO,MW and IU may effectively improve the effects of interventions.The present studies prove that the network model can deepen our understanding of the dynamic interactions between symptoms and the complex relationship between core symptom and related cognitive factors at the group level,and provide some theoretical basis for the development and improvement of accurate preventions and interventions for GAD.