Psychophysiological assessment during exposure in driving phobic patients

A comprehensive assessment of fear or anxiety requires measurement of both self-report and physiological responses. Respiratory abnormalities have been rarely examined during real-life exposure, although they are an integral part of fear. Twenty-one women with a specific driving phobia and 17 nonphobic women were psychophysiologically monitored during 2 highway-driving sessions; phobic women completed an additional session. Respiratory movements, end-tidal partial pressure of carbon dioxide, an electrocardiogram, skin conductance, and skin temperature were recorded. Phobic patients differed from control participants both physiologically and experientially before, during, and after exposure. Effect size during exposure was large for the authors' measure of hyperventilation. Discriminant analysis indicated that multiple physiological measures contributed nonredundant information and correctly classified 95% of phobic and control participants. Thus, selected respiratory and autonomic measures are valid diagnostic and therapeutic outcome criteria for this situational phobia.     

Context-specificity of relapse: effects of therapist and environmental context on return of fear.

Context-specificity of fear extinction was tested among 65 participants who were fearful of spiders by manipulating the contexts used for exposure treatment and two-week follow-up assessment. Context was defined by both meaningful (presence of a particular therapist) and incidental (room location and furnishings) environmental cues. Distinct phobic stimuli were used to examine interactions of context with stimulus. Physiological, behavioral and verbal indices of fear were measured. Results provided modest support for context-specific return of fear. With one stimulus, participants assessed in a non-treatment context at follow-up exhibited greater returns in heart rate levels. In addition, three of four participants who could not touch the stimulus at follow-up had been tested in a non-treatment context. Future investigations may benefit from greater distinctions between contexts or manipulation of contextual features more directly relevant to fear. Finally, post hoc analyses identified high trait anxiety, slow treatment response, recovery of phobic cognitions and long duration/high intensity phobic encounters post-treatment as significant predictors of increased return of fear.     

Repeated exposure of flight phobics to flights in virtual reality

The present study examined the effects of repeated exposure of flight phobics to flights in virtual reality (VR). Flight phobics were randomly assigned either to complete one VR test flight followed by four VR exposure flights (VR group; N=15) in one lengthy session or to complete one VR test flight followed by a lengthy relaxation training session (relaxation group; N=15). All participants completed a second VR test flight at the end of the session. Fear reports and physiological fear reactions (heart rate, skin conductance level) during VR exposures were registered, and fear of flying was assessed psychometrically from 3 weeks before to 3 months after exposure. Exposure to VR flights elicited subjective and physiological fear responses in flight phobics, and these responses attenuated within and across VR flights. Fear reduction associated with repeated VR exposure was greater than fear reduction caused by relaxation training. Fear of flying improved in both treatment groups, but several outcome measures indicated greater effects in the VR treated group than in the relaxation group. These findings indicate that exposure in virtual reality may offer a new and promising approach for the treatment of fear of flying.     

Attentional bias and evoked heart-rate response in specific phobia

The relationship between the evoked heart-rate (HR) reaction to phobic pictures and the attentional bias was investigated in specific phobics. Forty-five specific phobic and 39 control participants were shown phobia-related pictures while HR was being recorded; they were administered the modified dot-probe task, the modified Stroop task, and gave subjective ratings of pictures. Unlike control participants, specific phobics showed HR acceleration to phobia-related pictures, which was significantly correlated with their fear ratings, and a significant Stroop interference effect. There were no group differences with regard to an attentional bias in the dot-probe task but early deceleration of the HR reaction to phobic pictures was related to more pronounced selective attention toward these stimuli in phobics. The results provide partial support for Cook and Turpin's (1997) conjecture of a relationship between the early decelerative orienting component of the HR reaction and the selective attentional bias in phobia.     

Assessing Fear of Storms and Severe Weather: Validation of the Storm Fear Questionnaire (SFQ)

To date, research on storm phobia has been limited by a lack of validated self-report measures for evaluating the severity of anxiety, phobic avoidance, and distress associated with storms and severe weather. The current research presents the development and validation of the Storm Fear Questionnaire (SFQ), a 15-item self-report questionnaire that assesses the cognitive, affective, and behavioral aspects thought to be associated with Storm Phobia in adults. Three studies were conducted to assess 1) the factor structure, internal consistency, and convergent and discriminant validity of the SFQ, 2) the test-retest reliability of the SFQ, 3) the extent that scores on the SFQ were associated with subjective anxiety ratings during a Behavioral Approach Test (BAT) involving exposure to a virtual thunderstorm, and the extent to which SFQ scores distinguished community participants with versus without a fear of storms. Exploratory factor analyses supported a one-factor model with good internal consistency (Cronbach’s α?=?.95), good convergent and discriminant validity with self-report measures of anxiety, worry, depression, and other specific phobias, and acceptable test-retest reliability. Moreover, there was a significant positive association between SFQ scores and anxiety ratings following the BAT involving exposure to a virtual thunderstorm and participants with a high fear of storms reported significantly higher SFQ scores than those with a low fear of storms. In sum, the SFQ has good psychometric properties and appears to be a valuable tool for assessing the severity of fear associated with storms and severe weather. Research evaluating the diagnostic and clinical utility of the SFQ is still needed.     

Blushing and physiological arousability in social phobia

Blushing is the most prominent symptom of social phobia, and fear perception of visible anxiety symptoms is an important component of cognitive behavioral models of social phobia. However, it is not clear how physiological and psychological aspects of blushing and other somatic symptoms are linked in this disorder. The authors tested whether social situations trigger different facial blood volume changes (blushing) between social phobic persons with and without primary complaint of blushing and control participants. Thirty social phobic persons. 15 of whom were especially concerned about blushing, and 14 control participants were assessed while watching an embarrassing videotape, holding a conversation, and giving a talk. Only when watching the video did the social phobic persons blush more than controls blushed. Social phobic persons who complained of blushing did not blush more intensely than did social phobic persons without blushing complaints but had higher heart rates, possibly reflecting higher arousability of this subgroup.     

Individual response differences in spider phobia: comparing phobic and non-phobic women of different reactivity levels

In contrast to previous stress research, studies concerning phobic disorders have never systematically investigated individual response differences between phobic participants integrating numerous different response measures. The aim of this article is to clarify the existence of significant individual response differences in psychophysiological responses (e.g., heart rate, skin conductance responses (SCR), corrugator, cortisol), subjective ratings (e.g., valence, arousal), and avoidance behavior in 46 spider phobic and 44 non-phobic women when exposed to 20 phobic and 20 neutral pictures. Previous studies that did not attend to individual response differences showed that, during phobic stimulation, phobic individuals have increased psychophysiological responses (heart rate, SCR, and corrugator responses), more negative valence rating, and more subjective arousal than non-phobic individuals. These results were confirmed by our data. With regard to individual response uniqueness, 1/3-2/3 of spider-phobic women with low responsiveness in heart rate, cortisol, and avoidance behavior were indistinguishable from non-phobic women during phobic stimulation. With SCR, corrugator EMG, and subjective ratings, no individual response uniqueness was found. Based on the findings, exposure therapy might be improved by tailoring interventions to individuals with a therapeutic focus on those psychophysiological measures that show the highest individual responsivity.     

状态焦虑对条件恐惧习得和消退的影响

采用44名正常女性大学生作为被试, 通过心理社会压力暴露的方法诱发焦虑组被试的状态焦虑, 采用主观预期值作为指标, 考察焦虑对条件恐惧习得和消退的直接影响, 并探讨这种影响是否也表现在评价性条件作用上。结果表明：心理社会压力暴露显著提高了焦虑组被试的状态焦虑。在习得阶段, 状态焦虑降低了被试对条件刺激的辨别条件恐惧反应, 具体而言, 状态焦虑降低了被试对CS+的主观预期值, 但是却提高了对CS?的主观预期值; 在消退阶段, 状态焦虑抑制了被试对条件刺激的消退。状态焦虑的影响也表现在评价性条件作用上, 和控制组相比, 焦虑组在习惯化和消退阶段对条件刺激表现出了更为负性的效价评定。     

Individual response differences in spider phobia: Comparing phobic and non-phobic women of different reactivity levels

Abstract

In contrast to previous stress research, studies concerning phobic disorders have never systematically investigated individual response differences between phobic participants integrating numerous different response measures. The aim of this article is to clarify the existence of significant individual response differences in psychophysiological responses (e.g., heart rate, skin conductance responses (SCR), corrugator, cortisol), subjective ratings (e.g., valence, arousal), and avoidance behavior in 46 spider phobic and 44 non-phobic women when exposed to 20 phobic and 20 neutral pictures. Previous studies that did not attend to individual response differences showed that, during phobic stimulation, phobic individuals have increased psychophysiological responses (heart rate, SCR, and corrugator responses), more negative valence rating, and more subjective arousal than non-phobic individuals. These results were confirmed by our data. With regard to individual response uniqueness, 1/3–2/3 of spider-phobic women with low responsiveness in heart rate, cortisol, and avoidance behavior were indistinguishable from non-phobic women during phobic stimulation. With SCR, corrugator EMG, and subjective ratings, no individual response uniqueness was found. Based on the findings, exposure therapy might be improved by tailoring interventions to individuals with a therapeutic focus on those psychophysiological measures that show the highest individual responsivity.     

Return of fear: The role of inhibition

In a previous study investigating the relationship between subjective, physiological and behavioural changes during treatment of specific phobias, a marked between-session increase was found in subjective fear after high, but not after low intensity phobic stimulation although the groups showed similar fear ratings and heart rates immediately after treatment (Grey et al, 1979). It was hypothesized that the high intensity stimulation led to ‘treatment fatigue’; a state of deactivation, the recovery from which led to a return of fear.In this study high intensity in vivo stimulation was used for the treatment of phobic subjects under conditions of distributed and massed practice. No differences emerged between treatment conditions. A small group of Ss with a conspicuously high heart rate (mean level 120 bpm) when rating zero fear, showed a significant increase in fear after one week's interval, although they had shown similar improvement to the Ss during treatment. Subjects in both treatment conditions showed lower heart rate at all post-treatment assessments than pre-treatment. The high initial heart rate Ss continued to have higher heart rate than other Ss throughout the experiment, although they showed a decrease after treatment. It was only these Ss with desynchronously high heart rate, i.e. high heart rate with zero fear ratings, who suffered a return of fear, whereas high heart rate during high fear did not predict either response to treatment or return of fear. A further finding was a lack of correlation between the behavioural and physiological indices of fear, namely, between distance and heart rate at high levels of fear.     

Phobia-relevant illusory correlations: the role of phobic responsivity

The authors investigated the role of phobic responsivity in the generation of phobia-relevant illusory correlations. As a means of disentangling the contributions of prior fear and elicited fear responses, half of a group of phobic women received 1 mg alprazolam (n = 21), and half received a placebo (n = 22). A group of nonfearful women (n = 24) was included to control for prior fear per se. Participants were exposed to slides of spiders, weapons, and flowers that were randomly paired with a shock, a siren, or nothing. Postexperimental covariation estimates and on-line outcome expectancies were assessed. Irrespective of both prior and elicited fear, participants postexperimentally overassociated spiders and shock. Yet, only women with spider phobia displayed a persisting fear-confirming expectancy bias. This bias was similar for the placebo and alprazolam groups. Thus, the bias appeared to be due to preexisting phobogenic beliefs, whereas phobic responsivity played a negligible role.     

Emotional responding to fearful and disgusting stimuli in specific phobics

Individuals with small animal and blood-injection-injury (BII) phobias respond to phobia-relevant stimuli with both fear and disgust. However, recent studies suggest that fear is the dominant emotional response in animal phobics whereas disgust is the primary emotional response in BII phobics. The present study examined emotional responding toward pictures of spiders, surgical procedures, and two categories of general disgust elicitors (rotting food and body products) among analogue spider phobics, BII phobics, and nonphobics. Dominant emotional responses to phobia-relevant stimuli clearly differentiated the groups. as spider phobics were more likely to be classified as primarily fearful when rating pictures of spiders (74%), whereas BII phobics were more likely to be classified as primarily disgusted when rating pictures of surgical procedures (78%). Discriminant function analyses revealed that disgust ratings, but not fear ratings, of the phobic pictures were significant predictors of phobic group membership. Both phobic groups were characterized by elevated disgust sensitivity toward video and pictorial general disgust elicitors. Implications and suggestions for continued research examining fearful and disgusting stimuli in specific phobia are outlined.     

Self-report and physiological changes accompanying repeated imagining of a phobic scene.

Twenty female subjects were selected from a larger subject pool on the basis of their scores to the ‘snakes’ item on the Geer (1965) Fear Survey Schedule. Ten of the subjects were selected as phobic; the other ten were non-phobic controls. Heart rate, skin conductance and self-reports of fear and imagery vividness were continuously monitored while subjects repeatedly imagined a prescribed snake scene for a total of 15 trials. The phobic group reported more overall fear to the images. Further, while the nonphobic subjects reported progressively less fear over trials, the phobic subjects reported progressively more fear. The groups did not differ in rated imagery vividness. However, heart rate responses to the image differentiated the two groups. The non-phobic subjects showed a progression from cardiac acceleration in the early trials to a biphasic response pattern, deceleration preceding acceleration, in the later trials. In contrast, the phobic subjects demonstrated sustained acceleration in the later trials. The groups did not differ in skin conductance response amplitude.     

Latent growth curve analysis of fear during a speech task before and after treatment for social phobia

Models of social phobia highlight the importance of anticipatory anxiety in the experience of fear during a social situation. Anticipatory anxiety has been shown to be highly correlated with performance anxiety for a variety of social situations. A few studies show that average ratings of anxiety during the anticipation and performance phases of a social situation decline following treatment. Evidence also suggests that the point of confrontation with the feared stimulus is the peak level of fear. No study to date has evaluated the pattern of anxious responding across the anticipation, confrontation, and performance phases before and after treatment, which is the focus of the current study. Socially phobic individuals (N = 51) completed a behavioral avoidance task before and after two types of manualized cognitive behavioral therapy, and gave ratings of fear during the anticipation and performance phases.Results from latent growth curve analysis were the same for the two treatments and suggested that before treatment, anxiety sharply increased during the anticipation phase, was highly elevated at the confrontation, and gradually increased during the performance phase. After treatment, anxiety increased during the anticipation phase, although at a much slower rate than at pretreatment, peaked at confrontation, and declined during the performance phase. The findings suggest that anticipatory experiences are critical to the experience of fear for public speaking and should be incorporated into exposures.     

Development and Initial Validation of an Abbreviated Spider Phobia Questionnaire Using Item Response Theory

An abbreviated Spider Phobia Questionnaire (SPQ) was developed using methods based in item response theory. Fifteen of the 31 SPQ items that demonstrated good to excellent discrimination along the spider fear continuum were retained in Study 1 that consisted of 1,555 nonclinical and clinical participants. The SPQ-15 demonstrated good internal consistency and correlated highly with the full SPQ. Structural equation modeling revealed that the SPQ-15 demonstrated excellent convergent validity, with strong associations with small animal disgust and other phobic symptoms. Supportive evidence was also found for divergent validity in relation to panic-related symptoms. The SPQ-15 was uniquely predictive of avoidance behavior and fear and disgust responding towards spiders in nonclinical, analogue, and treatment-seeking samples in Studies 2, 3, and 4. Lastly, in Study 5, the SPQ-15 was sensitive to the effects of exposure-based treatment. These findings suggest that the SPQ-15 has considerable strengths, including decreased assessment and scoring time while retaining high reliability, validity, and sensitivity.     

Emotional responses in spider fear are closely related to picture awareness

Theories of emotion propose that responses to emotional pictures can occur independently of whether or not people are aware of the picture content. Because evidence from dissociation paradigms is inconclusive, we manipulated picture awareness gradually and studied whether emotional responses varied with degree of awareness. Spider fearful and non-fearful participants viewed pictures of spiders and flowers at four levels of backward masking while electrodermal activity and heart rate were measured continuously. Recognition ratings confirmed that participants’ picture awareness decreased with masking. Critically, effects of spider fear on emotion ratings and heart rate also decreased with masking. These findings suggest that effects of spider fear on emotion ratings and heart rate are closely related to picture awareness.     

Processing of phobic stimuli and its relationship to outcome

In the present study, we explored factors related to successful treatment outcome in a sample of participants with fear of spiders. We specifically examined the relationship of general memory, memory for the phobic stimulus, memory for anxious responses, and perceived self-efficacy to treatment outcome. Forty-eight participants who were afraid of spiders participated in two sessions of in vivo exposure therapy. On day 1, participants completed measures of general memory, memory for the phobic stimulus, recall of anxiety level during exposure tasks, and self-efficacy during exposure tasks. At post-treatment, better memory for anxious responses, but not memory for the phobic stimulus, was related to lower anticipatory and actual anxiety. Greater self-efficacy, on the other hand, was related to better behavioral performance.     

Effect of worrisome and relaxing thinking on fearful emotional processing

This study replicated and extended previous data suggesting that worry inhibits emotional processing of fearful imagery. Female participants categorized as either victimization-fearful (N = 24) or victimization and speech-fearful (N = 27) completed trials of worrisome or relaxing thinking and tone-cued imagery. For each trial, participants engaged in 30 s of relaxing or worrisome (speech or victimization) thinking and then imagined speech or victimization fear scenes for 15 s. Heart rate and facial electromyography activity at the corrugator supercilii region were measured during the think and imagery periods to estimate degree of emotional processing of the fear imagery. Consistent with earlier findings, there was greater heart rate suppression during fearful imagery after a period of worry as opposed to relaxation. This finding, however, may have been the result of physiological differences between worrisome and relaxation thinking. Corrugator activation during thinking showed a similar pattern as the heart rate data while corrugator activation during fearful imagery was dependent on the baseline employed. These data, in combination with the imagery ratings data, suggest that worry may be an unsuccessful strategy for avoiding the physiological activation associated with emotional processing.