Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden.
Stress Health. 2024 Apr;40(2):e3319. doi: 10.1002/smi.3319. Epub 2023 Sep 14.
Previous lab findings have indicated that excessive worry may impair cognitive performance and problem solving capabilities but it is unclear if excessive worry also leads to broader impairments in general functioning. We report a secondary process data analysis of a large randomized waitlist-controlled trial (N = 670) of a self-guided online psychological intervention for dysfunctional worry related to the Covid-19 pandemic. Specific aims were to investigate (1) if improvements in general functioning were mediated by reductions in worry related to Covid-19 during the acute intervention phase, and (2) if reduced worry related to Covid-19 during acute intervention phase had a positive long-term impact on general functioning up to 1 year after the end of the intervention. To address aim 1, we used a mediation analysis framework where outcome (general functioning measured with an adapted version of the Work and Social Adjustment Scale) and the hypothesized mediator (worry measured with an adapted version of the Generalised Anxiety Disorder 7-Item Scale) were administered weekly during the controlled phase of the trial of 3 weeks. To address aim 2, we investigated if reductions in worry during the 3-week treatment period predicted improved general functioning at 1- and 12 months after treatment completion. Results showed that improvements in general functioning at week 3 were mediated by reductions in worry during the first 2 weeks of treatment (indirect effect estimate -0.08; 95% CI -0.15, -0.02). A sensitivity analysis indicated that the mediation effects dropped significantly when the residual correlation values between the mediator and the outcome exceeded r = 0. A reversed causation model was not significant. Additionally, reductions in worry during treatment predicted subsequent improvements in general functioning at both 1- and 12-month follow-ups (p < .05, -.001). Altogether, these results provide further support of the importance of targeting worry as a way to improve functioning among the large population of individuals with high levels of worry.
先前的实验室研究结果表明，过度担忧可能会损害认知表现和解决问题的能力，但目前尚不清楚过度担忧是否也会导致一般功能的广泛受损。我们报告了一项针对大规模随机候补对照试验（N=670）的二次过程数据分析结果，该试验为与 COVID-19 相关的功能失调性担忧提供了自我指导的在线心理干预。具体目标是调查（1）在急性干预阶段，担忧与 COVID-19 相关的减少是否会通过一般功能的改善来介导，以及（2）在急性干预阶段，担忧与 COVID-19 相关的减少是否会对干预结束后 1 年内的一般功能产生积极的长期影响。为了实现目标 1，我们使用了一个中介分析框架，其中结局（用经过改编的工作和社会适应量表来衡量一般功能）和假设的中介变量（用经过改编的广泛性焦虑症 7 项量表来衡量担忧）在试验的 3 周对照期内每周进行测量。为了实现目标 2，我们调查了在 3 周治疗期间的担忧减少是否预测了治疗完成后 1 个月和 12 个月时一般功能的改善。结果表明，第 3 周的一般功能改善是由治疗前两周内担忧减少所介导的（间接效应估计值 -0.08；95%置信区间 -0.15，-0.02）。敏感性分析表明，当中介变量和结局之间的剩余相关值超过 r=0.08 时，中介效应显著下降。反向因果关系模型不显著。此外，治疗期间的担忧减少预测了治疗后 1 个月和 12 个月随访时一般功能的后续改善（p<0.05，-0.001）。总之，这些结果进一步支持了将担忧作为一种针对大量高担忧人群改善功能的方法的重要性。
