Phallic and seminal masculinity: A theoretical and clinical confusion

Both inside and outside psychoanalysis, the word, 'seminal', is used to praise a creative contribution to science and culture. Rarely, however, does it refer to male procreativity, to the structures and functions that subserve it or to the anxiety related to a threat to it. This situation becomes evident in the concept of castration anxiety, which typically refers, with Freud, to cutting off the penis and not to extirpating the testicles. This phallic theory has been debated, repudiated and ignored. While there is an alternative literature on non-phallic masculinity, it is scattered and rarely refers to seminal function. Freud's theory meets his requirement for a well-articulated representation of absolute loss as an experience, but this clear structure – and its repudiation – obscure the observation and theory of the internal world of the male. I propose the concepts of 'seminal masculinity' and 'seminal castration', which I ground in Melanie Klein's concept of depressive anxiety. I contrast them with phallic masculinity and phallic castration anxiety, which I ground in her concept of paranoid–schizoid anxiety. I argue that they meet Freud's requirement that castration be a potential experience and that understanding masculinity demands such a basis.     

Conceptual,methodological, and clinical issues in the assessment of anxiety disorders

Many conceptual, methodological, and clinical issues remain unresolved in the assessment of anxiety disorders. Despite the prevalence, incidence, chronicity, and severity of anxiety disorders, research efforts and funding have fallen behind with regard both to other disorders and to addressing critical issues in the field. The primary objective of this paper is to provide a scientific critique regarding a number of often ignored yet salient considerations in anxiety-disorders assessment. Critical analyses of and recommendations regarding the multidimensional nature of anxiety, comorbidity, uniformity myths, synchrony, normative comparisons, psychometric properties of measures, and treatment integrity are offered. Finally, promising areas of clinical research are presented to enhance further the current understanding of the complexities inherent in assessing anxiety disorders.Preparation of this paper was supported in part by NIMH Grant MH36299.     

自我聚焦对社交焦虑的影响：抽离与正念的调节作用

本文旨在探讨抽离和正念在自我聚焦对社交焦虑影响关系中的作用。两个研究分别采用相关法和实验法,探究自我聚焦内容（冗思、正念）和反思方式（浸入、抽离）对社交焦虑的交互影响。结果：问卷数据显示,抽离在自我聚焦注意影响社交焦虑的关系中起着调节作用,无论低抽离倾向还是高抽离倾向,自我聚焦注意都能预测社交焦虑,高抽离倾向减弱个体的社交焦虑感;实验结果表明,聚焦内容与反思方式两者交互作用于社交焦虑,浸入-聚焦冗思内容引发最强的社交焦虑,抽离-聚焦正念内容引发最弱的社交焦虑。结论：抽离和聚焦正念内容都最能有效缓解自我聚焦对社交焦虑的不良影响。     

Terror in the countertransference: extreme anxiety as a clinician and organisational leader and its effects

Experiencing fear is a central feature of managing disturbed states of minds. In this paper, I will describe the experience of being terrified by a patient who was overtaken by extreme anxiety. Aetiologically, I will suggest that the lack of containment created terror in her mind. I will also describe my experience of leadership in a voluntary organisation. Using Hopper’s concept of a fourth basic assumption, I will highlight the omnipresence of annihilatory anxiety in an example of organisational trauma. I will suggest that focusing on the issues of countertransference, working through experiences of being terrorised and paying attention to how you emotionally respond are crucial to lessening terror.     

Social Anxiety and Friendship Quality over Time

Abstract

High social anxiety in adults is associated with self-report of impaired friendship quality, but not necessarily with impairment reported by friends. Further, prospective prediction of social anxiety and friendship quality over time has not been tested among adults. We therefore examined friendship quality and social anxiety prospectively in 126 young adults (67 primary participants and 59 friends, aged 17–22 years); the primary participants were screened to be extreme groups to increase power and relevance to clinical samples (i.e., they were recruited based on having very high or very low social interaction anxiety). The prospective relationships between friendship quality and social anxiety were then tested using an Actor–Partner Interdependence Model. Friendship quality prospectively predicted social anxiety over time within each individual in the friendship, such that higher friendship quality at Time 1 predicted lower social anxiety approximately 6 months later at Time 2. Social anxiety did not predict friendship quality. Although the results support the view that social anxiety and friendship quality have an important causal relationship, the results run counter to the assumption that high social anxiety causes poor friendship quality. Interventions to increase friendship quality merit further consideration.     

抑郁和焦虑与心律失常

焦虑抑郁广泛存在于各种心血管疾病中已成共识。心律失常患者合并心理问题在临床上十分常见,焦虑抑郁导致的自主神经对心脏的调节失衡会进一步促使心律失常的发生与发展。对于非器质性心脏病,β受体阻滞剂与抗焦虑药物合用有很好的疗效;器质性心脏病患者并发心律失常时患者的焦虑抑郁会进一步加重,甚至导致恶性室性心律失常的发生,增加器质性心脏病患者的病死率;心律失常介入治疗引起的焦虑抑郁更为常见。临床上对焦虑抑郁症状要有充分的重视,积极识别并诊断,以期进一步提高心律失常患者的生活质量,减少病死率。     

Relation of anxiety to hostility in the course of inpatient treatment

The purpose of this study was to examine relationships between anxiety and hostility in hospitalized psychiatric patients, with the passage of time. The used psychometric instruments were the state of anxiety subscale (sA) of the Delusions Symptoms States Inventory (DSSI) and the Hostility and Direction of Hostility Questionnaire (HDHQ). The two questionnaires were administered during the first week of admission and completed again before the discharge of the patient. Two groups of patients emerged and were examined according to the sA scores reported on the second measurement. Group I (n = 44) consisted of patients reporting lower anxiety scores on the second measurement and Group II (n = 22) consisted of patients reporting higher anxiety scores on the second measurement. In Group I, the drop of anxiety scores was accompanied by parallel and highly significant drops of all hostility scores. In Group II, the increased anxiety scores were accompanied by non‐significant or marginally significant changes of hostility scores. The notion that hostility and anxiety are positively related was not fully supported. Also, the opposite thesis that there is a negative relationship between anxiety and hostility was not supported. The present study suggests that the levels of anxiety during the course of inpatient treatment are a factor influencing the temporal relationship between anxiety and hostility. Aggr. Behav. 00:1–6. 2005. © 2005 Wiley‐Liss, Inc.     

The Interaction of Extraversion and Anxiety Sensitivity on Social Anxiety: Evidence of Specificity Relative to Depression

Neuroticism and extraversion have been linked to the etiologies and course of anxiety and mood disorders, such that neuroticism is broadly associated with numerous disorders and extraversion is most strongly associated with social anxiety and depression. While previous research has established the broad associations between temperament and emotional disorders, less is known about the specific, proximal factors that are associated with them, and very few studies have situated these risk factors into a larger etiological model that specifies how they may relate to one another. The current study examined the interaction of extraversion and anxiety sensitivity (AS) in predicting social anxiety symptoms in a large, diagnostically diverse clinical sample (N = 826). Symptoms were assessed with self-report and dimensional interview measures, and regression analyses were performed examining the main effects and interaction of extraversion and AS (examining both total and lower-order components) on social anxiety. Results showed that at higher levels of AS, the inverse relationship between extraversion and social anxiety was stronger, and the social concerns component of AS is responsible for this effect. This interaction was also observed with regard to depression symptoms, but the interaction was not present after accounting for shared variance (i.e., comorbidity) between depression and social anxiety symptoms. Clinical and theoretical implications of the results are discussed.     

Development and Evaluation of the Anxiety Disorder Diagnostic Questionnaire

A model of anxiety that emphasizes a single common pathology across diagnostic categories is gaining support and influencing nosological and treatment approaches of anxiety disorders. As research in this area continues to grow, a need exists for an assessment tool of the theorized single anxiety pathology that is unbiased toward any particular anxiety diagnosis. The Anxiety Disorder Diagnostic Questionnaire (ADDQ) was developed as a screening tool for the presence of clinical fear and anxiety irrespective of diagnoses. It is a brief four-section index developed to assess fear, anxiety/worry, escape/avoidance behaviors, physiological symptoms, and associated distress and interference. The ADDQ was tested for reliability and validity in two samples: 146 undergraduate students who were given the ADDQ along with a variety of other commonly-used measures of anxiety and 94 outpatients representing a mix of diagnoses (28.2% panic disorder with or without agoraphobia, 44.6% social anxiety disorder, 20.7% generalized anxiety disorder, 3.3% anxiety disorder not otherwise specified, 2.1% obsessive–compulsive disorder, and 1.1% posttraumatic stress disorder). Internal consistency of the instrument was strong, and a one- or two-factor solution was found to be the best fit to the data. Convergent and discriminant validity was also demonstrated. Data from those clinical participants who completed a manualized cognitive–behavioral treatment program indicated a very strong concordance between change on the ADDQ and change in clinician severity ratings from a structured diagnostic interview. The findings offer support for the psychometric validity of the ADDQ in both clinical and nonclinical populations.     

冠心病患者的抑郁和焦虑

许多临床研究表明,冠心病患者常发生抑郁及焦虑。而在严重精神症状（如抑郁或/和焦虑）者中有较高的冠心病发生率。抑郁增加冠心病患者的不良心血管事件发生率,影响预后。其机制有如下几个方面：对医疗措施及生活方式改变的依从性差、血小板功能异常、血管内皮功能紊乱以及心率变异性降低。选择性5-羟色胺再摄取抑制剂由于其较好的耐受性且无明显的心血管副作用而应用于冠心病合并抑郁及焦虑的药物治疗并改善患者的生活质量。但仍需要更大规模的临床研究以确定抑郁及焦虑对冠心病预后的影响。临床上应更加关注焦虑对冠心病的影响,进一步探讨焦虑能否作为冠心病的危险因素。     

The effects of trait and state anxiety on attention to emotional images: An eye-tracking study

Attentional biases for threatening stimuli have been implicated in the development of anxiety disorders. However, little is known about the relative influences of trait and state anxiety on attentional biases. This study examined the effects of trait and state anxiety on attention to emotional images. Low, mid, and high trait anxious participants completed two trial blocks of an eye-tracking task. Participants viewed image pairs consisting of one emotional (threatening or positive) and one neutral image while their eye movements were recorded. Between trial blocks, participants underwent an anxiety induction. Primary analyses examined the effects of trait and state anxiety on the proportion of viewing time on emotional versus neutral images. State anxiety was associated with increased attention to threatening images for participants, regardless of trait anxiety. Furthermore, when in a state of anxiety, relative to a baseline condition, durations of initial gaze and average fixation were longer on threat versus neutral images. These findings were specific to the threatening images; no anxiety-related differences in attention were found with the positive images. The implications of these results for future research, models of anxiety-related information processing, and clinical interventions for anxiety are discussed.     

Comorbid anxiety and mood disorders among persons with social anxiety disorder.

Axis I comorbidity is associated with greater severity of social anxiety disorder. However, the differential effects of comorbid mood and anxiety disorders on symptom severity or treatment outcome have not been investigated. We evaluated 69 persons with uncomplicated social anxiety disorder, 39 persons with an additional anxiety disorder, and 33 persons with an additional mood disorder (with or without additional anxiety disorders). Those with comorbid mood disorders reported greater duration of social anxiety than those with uncomplicated social anxiety disorder. They were also judged, before and after 12 weeks of cognitive-behavioral group treatment and at follow-up, to be more severely impaired than those with no comorbid diagnosis. In contrast, persons with comorbid anxiety disorders were rated as more impaired than those with no comorbid diagnosis on only a single measure. Type of comorbid diagnosis did not result in differential rates of improvement of social anxiety disorder.     

Anxiety-linked attentional bias: backward glances and future glimpses

ABSTRACT

This brief reflection considers some of the important developments in anxiety-linked attentional bias research that have marked the three decades since the launch of Cognition and Emotion, and also identifies several challenges and opportunities that lie ahead. I suggest that the steady increase in our capacity to distinguish differing facets of attentional bias and alternative dimensions of anxiety vulnerability, together with the advent of attentional bias modification techniques that can illuminate causality, has enriched theoretical understanding and created the exciting potential for clinical translation. In order to fully capitalise on this potential, I propose that researchers should address the challenge of enhancing the psychometric properties of our assessment measures, and developing training procedures that not only modify attentional bias more effectively, but that motivate sustained patient engagement. I end with some personal advice to young investigators developing their research careers within this stimulating and rewarding field of scientific inquiry.     

Anxiety reactivity and anxiety perseveration represent independent dimensions of anxiety vulnerability: an in vivo study

Trait anxiety is a relatively stable disposition reflecting an individual's tendency to experience anxious symptomatology, typically measured using questionnaires such as the Spielberger Trait Anxiety Inventory (STAI-T). While trait anxiety commonly is considered a unitary construct, recent questionnaire research suggests that two different dimensions of anxiety vulnerability account for independent variance in trait anxiety scores. These dimensions are anxiety reactivity (AR), reflecting the intensity of anxiety reactions to stressors, and anxiety perseveration (AP), reflecting the persistence of anxiety symptoms. This study investigated whether in vivo measures of these two facets independently contribute to anxiety vulnerability. Seventy-two participants were exposed to a novel stress task designed to yield measures of AR and AP. Regression analysis determined that these in vivo measures were unrelated to each other, and each accounted for independent variance in trait anxiety scores. The implications of these findings for the assessment and understanding of anxiety vulnerability are discussed.     

The Role of Anxiety Sensitivity and Mindful Attention in Anxiety and Worry About Bodily Sensations Among Adults Living With HIV/AIDS

The current study examined cognitive factors that may be relevant to understanding anxiety and worry about bodily sensations among an HIV/AIDS population. Specifically, this investigation tested the main and interactive effects of anxiety sensitivity and mindful attention on anxious arousal, bodily vigilance, interoceptive fear, and HIV symptom distress among 164 adults with HIV/AIDS. Results indicated that anxiety sensitivity was positively related to anxious arousal, bodily vigilance, and interoceptive fear, but not HIV symptom distress. Mindful attention was negatively related to anxious arousal, interoceptive fear, and HIV symptom distress, but not bodily vigilance. These main effects for anxiety sensitivity and mindful attention were evident after controlling for disease stage, years with HIV, and demographic variables. There were no interactive effects between anxiety sensitivity and mindful attention. Results are discussed in terms of the clinical implications for identifying and treating anxiety and worry about bodily sensations among adults with HIV/AIDS. Limitations of this study include the use of cross-sectional data and self-report assessments.     

Specificity of peer difficulties to social anxiety in early adolescence: categorical and dimensional analyses with clinical and community samples

Background and Objectives: We investigated the specificity of social difficulties to social anxiety by testing associations of social anxiety and other anxiety presentations with peer acceptance and victimization in community and treatment-seeking samples of adolescents aged 12–14 years.

Design: Cross-sectional, quantitative survey.

Methods: Adolescents from the community (n?=?116) and a clinical setting (n?=?154) completed ratings of anxiety symptoms, perceived social acceptance, and peer victimization. Their parents also completed ratings of the adolescents’ anxiety and social acceptance.

Results: Social acceptance was lowest among adolescents with social anxiety disorder (SAD) and lower among adolescents with other anxiety disorders than in the community sample. Anxiety symptoms were negatively correlated with social acceptance, but these associations were not unique to social anxiety symptoms. Girls in the community sample reported more overt victimization than girls with SAD and with other anxiety diagnoses. Relational victimization was associated with social and nonsocial anxiety symptoms only in the community sample.

Conclusions: Our findings supplement recent laboratory-based observational studies on social functioning among adolescents with SAD and other anxiety disorders. Although social anxiety may be associated with unique social skill deficits and impairment, concerns about peer relations should also be considered among adolescents with other anxiety symptoms.     

Measurement and correlates of sport-specific cognitive and somatic trait anxiety: The sport anxiety scale

Abstract

Previous research indicates the viability of a distinction between cognitive and somatic components of the anxiety response, and multidimensional anxiety scales have proven useful in relating cognitive and somatic anxiety to behavioral outcomes. This article describes the development and validation of a sport-specific measure of cognitive and somatic trait anxiety. The Sport Anxiety Scale measures individual differences in Somatic Anxiety and in two classes of cognitive anxiety, Worry and Concentration Disruption. Both exploratory and confirmatory factor analyses supported these dimensions in several different athlete samples. Psychometric properties of the Sport Anxiety Scale are described, as are its relations with other psychological measures and with precompetition affective state measures. In the last of the four studies reported, scores on the Concentration Disruption scale were negatively related to the performance of college football players over the course of a season. The studies suggest that the Sport Anxiety Scale may be useful in defining sport-related anxiety more sharply and assessing how the cognitive and somatic anxiety components relate to performance and other outcome measures in sport.     

The relationship between intrinsic and extrinsic religiosity and competitive anxiety

ABSTRACT

The present study examined the relationship between religiosity and competitive anxiety in college athletes and whether there were differences in competitive anxiety for intrinsically religious and extrinsically religious individuals. College athletes (N?=?95) from three separate sports from the NCAA completed a questionnaire that included the Age-Universal I/E Scale, the Competitive State Anxiety Inventory-2 Revised, open-ended questions on habits related to religion, and demographic items. Results revealed no significant relationship between intrinsic and extrinsic religiosity and competitive anxiety. Extrinsically religious athletes had higher somatic anxiety than intrinsically religious athletes. The majority of participants (77%) reported praying before games primarily for comfort. Athletes turn to religion to calm their nerves but it is important to understand that their approach to religion may relate to increased anxiety. This information is useful for sport practitioners and coaches as they seek to help their athletes seek an intrinsic approach to religion in sport.     

Modelling relationships between cognitive variables during and following public speaking in participants with social phobia

Cognitive models of social phobia predict that several cognitive processes will mediate the relationship between trait levels of social anxiety and the extent of anxiety experienced in a specific social-evaluative situation. The current study aimed to provide a test of these relationships. Over 200 clinical participants with social phobia completed measures of their general social anxiety and a week later performed a brief impromptu speech. They completed a measure of state anxiety in response to the speech as well as questionnaires assessing several cognitive constructs including focus of perceived attention, perceived performance, and probability and cost of negative evaluation. A week later, they completed measures of negative rumination experienced over the week, as well as a measure of the recollection of their perceived performance. Path analysis provided support for a model in which the cognitive factors mediated between general social anxiety and the degree of anxiety experienced in response to the speech. A second model supported the theory that negative rumination mediated between characteristic social anxiety and negative bias in the recollection of performance.     

Anxiety reactivity and anxiety perseveration represent dissociable dimensions of anxiety vulnerability: A replication and extension

Trait anxiety is a unitary construct reflecting individual differences in the tendency to experience anxious symptomatology, typically measured with questionnaires such as the Spielberger Trait Anxiety Inventory (STAI‐T). Recent research by Rudaizky, Page, and MacLeod has found evidence that two different dimensions of trait anxiety account for independent variance in trait anxiety scores. These dimensions are anxiety reactivity (AR), reflecting the probability of experiencing an anxious reaction, and anxiety perseveration (AP), reflecting the persistence of anxious symptoms once elicited. There are two key issues addressed in this study: first, the replicability of Rudaizky et al.'s findings and second, the ability of the measures of AR and AP developed by Rudaizky et al. to predict independent variance in STAI‐T scores after statistically controlling for variance shared with a measure of depression. Regression analysis determined that AR and AP do account for independent variance in STAI‐T trait anxiety scores even after statistically controlling for depression. The implications of these findings for the understanding of anxiety vulnerability are discussed.