Metacognition and mindfulness are central to contemporary accounts of anxiety, yet their comparative profiles across social anxiety disorder (SAD) and panic disorder (PD) remain insufficiently defined. The objective of this study is to compare metacognition and mindfulness across SAD, PD and healthy controls (HC) and to examine how these processes predict disorder specific severity. Adults with SAD (n = 47), PD (n = 50) and HC (n = 50) participated, for a total of 147 individuals. Participants completed the Metacognitions Questionnaire 30 (MCQ-30), the Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF) and disorder-specific severity measures. Group differences were tested, followed by multiple linear regressions predicting severity within each clinical group from MCQ-30 subscales and FFMQ-SF facets. Metacognitive dysfunction was higher in SAD and PD than in HC, with the clearest separations in cognitive self-consciousness and the need to control thoughts. Mindfulness was lowest in SAD, intermediate in PD and highest in HC. In regression analyses, only mindfulness variables predicted severity in SAD, with higher observing and higher nonjudging associated with lower symptom levels. In PD, the need to control thoughts was the sole metacognitive predictor positively associated with severity; other metacognitive and mindfulness facets were not significant. Metacognition and mindfulness index a shared liability across anxiety but show disorder-specific signatures. In SAD, mindfulness facets related to observing and nonjudging are most relevant for severity, whereas in PD, control-oriented metacognitive beliefs are most relevant. These patterns identify focused targets for future longitudinal and experimental studies and may inform disorder-sensitive intervention strategies.

Prior work found microglial acid-sensor T-cell death-associated gene 8 (TDAG8) mediates panic-relevant responses to interoceptive stressor CO2 inhalation in male mice. Yet panic disorder is more common in women and panic attack symptoms vary in men and women. Here, we investigated sex differences in CO2-evoked behavioral and physiological responses in mice. We also investigated the role of TDAG8 in regulating CO2 inhalation-evoked fear-relevant behaviors and hyperventilation, as well as microglial morphology following CO2 inhalation in female mice. We found CO2 inhalation evoked greater fear-relevant behaviors and hyperventilation in female compared to male mice. Contrary to prior findings in males, we found TDAG8 deletion did not affect fear-relevant defensive responses to CO2 inhalation in females. However, TDAG8 deletion significantly attenuated CO2-evoked hyperventilation in females. Previous work in male mice showed CO2 inhalation induces morphological indicators of microglial activation within circumventricular organ the subfornical organ (SFO) in a TDAG8-dependent manner. Consistent with males, TDAG8 deletion in females attenuated morphological indicators of microglial activation following CO2 inhalation within the SFO, but not within another TDAG8-expressing circumventricular organ, the organ vasculosum of the lamina terminalis (OVLT). This suggests a divergence in the role of TDAG8 in mediating behavioral versus physiological responses to panicogen CO2 inhalation, though effects on SFO microglia are consistent. Together these data highlight important sex differences in behavioral and physiological responses to panicogen, CO2 inhalation. They also highlight the need to consider phenotypic differences when exploring molecular mechanisms and circuitry driving panic-relevant outcomes in males and females.

Panic disorder is a highly prevalent and impairing diagnosis in veterans. Despite consistent efficacy findings in community samples, few studies have investigated evidence-based psychotherapies in veterans with panic disorder, limiting the understanding of their utility and deployment in Veterans Affairs (VA) settings. The present study preliminarily investigated cognitive behavioral therapy (CBT) for panic disorder via a non-controlled design in a treatment-seeking veteran sample with panic disorder at the VA. Of the 41 veterans initiating treatment, 28 (68.3%) participants completed at least eight sessions of psychotherapy. In general, participants evidenced medium-to-large post-treatment effects across disorder-specific symptoms (panic and anxiety symptomatology), comorbid presentations (symptoms of depression and posttraumatic stress disorder), and overall functioning. Disorder-specific symptom effects remained stable for six months after psychotherapy was terminated. In addition, the delivery of CBT for panic disorder was further supported by positive indices of treatment feasibility, including treatment engagement, homework completion and engagement, and high participant satisfaction ratings. While recognizing that this study did not include a control group, the findings provide limited support for CBT treatment of panic disorder in veterans' settings, findings that will require confirmation in a multisite controlled clinical trial.

Objective: To adapt the Borderline Symptom List 23 (BSL-23) to Brazilian Portuguese and evaluate its psychometric properties in a large nonclinical sample.