Acquisition of phobias and anxiety response patterns in clinical patients

The ways in which phobic patients (N = 106; animal-, social- and claustrophobics) acquired their phobias were investigated in the present study. The results showed that a large majority (58%) of the patients attributed their phobias to conditioning experiences, while 17% recalled vicarious experiences, 10% instructions/information and 15% could not recall any specific onset circumstances. There was no clearcut relationship between the ways of acquisition and anxiety components (subjective, behavioral, physiological), nor did the conditioning and indirectly acquired phobias differ in severity. However, some interesting trends emerged in the data, showing that animal phobics who recalled conditioning experiences to a larger extent also responded physiologically. For patients with indirect onset experiences (for all three types of phobias) the reverse was true, i.e. they responded to a larger extent in a cognitive-subjective way, rather than with increased physiological arousal.     

Acquisition of agoraphobia, mode of onset and anxiety response patterns

The ways in which 80 agoraphobic patients had acquired their phobia were investigated. The patients were requested to answer a questionnaire concerning: (a) the origin of the phobia, with items relevant for conditioning experiences, vicarious experiences and experiences of negative information/instruction; (b) physiological reactions; (c) anticipatory anxiety; (d) negative thoughts while in the phobic situation. In addition, data on mode of onset, precipitating factors, family history of phobias, marital and occupational status and severity of the phobia were obtained. The reported anxiety reaction was conceptualized in terms of the Three-Systems Model of fear and anxiety, i.e. anxiety as composed of a physiological, cognitive and behavioral component. The results showed that a large majority (81%) of the patients attributed their phobias to conditioning experiences, while 9% recalled vicarious learning, none recalled instruction/information and 10% could not recall any specific onset circumstances at all. In another classification 46% of the patients had a rapid, 36% a gradual and 18% a slow onset of their phobias. There was no relationship between either the ways of acquisition, or the modes of onset, and the anxiety components, nor did the conditioning and the indirect groups differ in severity of phobic reactions.     

Interpretations for anxiety symptoms in social phobia

This study explored the ways in which people interpret visible physical symptoms of anxiety. A group of participants with social phobia (SP) and a nonclinical control (NCC) group completed either the Actor version or the Observer version of the Symptom Interpretation Scale (SIS), designed for the purposes of this study. The SIS asks participants to rate the extent to which each of eight interpretations is a likely explanation for a number of visible symptoms of anxiety. On the Actor version of the SIS, participants are asked to judge how their own anxiety symptoms are interpreted by others. On the Observer version of the SIS, participants are asked how they typically interpret anxiety symptoms that they notice in others. When participants were asked about anxiety symptoms that they themselves exhibit, people with social phobia were more likely than nonclinical controls to think that others interpreted these symptoms as being indicative of intense anxiety or a psychiatric condition and were less likely to think that others interpreted these symptoms as being indicative of a normal physical state. Data also suggested that people with social phobia have a more flexible cognitive style when asked to interpret anxiety symptoms exhibited by others than when asked about how others view their own anxiety symptoms. These findings are discussed in the context of recent psychological models of social anxiety and social phobia.     

Social phobia: individual response patterns and the effects of behavioral and cognitive interventions

In the present study, the role of individual response patterns in the treatment of social phobic patients was investigated. Seventy-four patients were diagnosed as social phobics. On the basis of extreme scores on a behavioral test (the Simulated Social Interaction Test) and on a cognitive measure (the Rational Behavior Inventory), the response patterns of 39 patients were analyzed, and the patients themselves were classified as either 'behavioral reactors' or 'cognitive reactors'. Half of the patients with each response pattern received a behavioral focused treatment, i.e. social skills training (SST), while the other half received a cognitive oriented treatment, i.e. rational emotive therapy (RET). Patients received group therapy in eight weekly sessions. Within-group differences showed a considerable improvement in all treatment groups. Between-group differences failed to lend support to the hypothesis that treatment that fits a response pattern (i.e. SST for behavioral reactors and RET for cognitive reactors) will result in a greater improvement than one that does not.     

Individual response patterns and the effects of different behavioral methods in the treatment of dental phobia

The present study investigated the importance of individual response patterns in the treatment of dental phobia. Thirty-seven outpatients with dental phobia were assessed during a behavioral test in the form of dental examination. Heart rate was continuously monitored both in the waiting-room and during the examination. The patient's cognitions during the test were assessed through a self-report scale. On the basis of these reactions the patients were divided into two groups: cognitive and physiological reactors. Within these groups the patients were randomly assigned to either a cognitively focused method (self-instructional training) or a physiologically focused method (applied relaxation). The patients were treated in groups of 4 for 9 sessions. The within-group comparisons showed that both treatments yielded significant improvements on almost all measures. The between-group comparisons did not show differential results, except for one measure in the physiological reactors. The results did not support the hypothesis that greater effects are achieved when the method used fits the patient's response pattern.     

Individual response patterns and the effects of different behavioral methods in the treatment of social phobia

The importance of individual response patterns in the treatment of phobic patients was examined in the present study. Forty psychiatric outpatients with social phobia were assessed with a social interaction test which was videotaped. Heart rate was continuously monitored during the test. On the basis of their reactions in the test situation, the patients were divided into two groups showing different response patterns; behavioral and physiological reactors. Within each group half of the patients were randomly assigned to a behaviorally focused method (social skills training) while the other half received a physiologically focused method (applied relaxation). The patients were treated individually in 10 sessions. The within-group comparisons showed that both treatments yielded significant improvements on most measures. The between-group comparisons showed that for the behavioral reactors, social skills training was significantly better than applied relaxation on six out of ten measures, and for the physiological reactors applied relaxation was significantly better than social skills training on three of the measures. The results support the hypothesis that greater effects are achieved when the method used fits the patient's response pattern.     

Social phobia: individual response patterns and the long-term effects of behavioral and cognitive interventions. A follow-up study

In this study the long-term effectiveness of Social Skills Training (SST) and Rational Emotive Therapy (RET), on social phobia was studied, as well as the differential influence of patient characteristics on treatment effectiveness. Fifty-seven patients were assessed 14 months after the post-test. Results showed that long-term effectiveness was independent of the response-pattern of the patients. Comparisons between methods, irrespective of the response-pattern of the patients, showed no differences in effectiveness in favor of either SST or RET. Explorative analysis indicated the potential predictive power for treatment-outcome of confederate ratings of overt behavior on the SSIT. Patients who needed additional treatment appeared to perform significantly worse on this measure at the pretest. No factors could be traced that predict relapse after a relatively successful treatment.     

Common and distinct patterns of affective response in dimensions of anxiety and depression

The authors examined the time course of affective responding associated with different affective dimensions--anxious apprehension, anxious arousal, and anhedonic depression--using an emotion-modulated startle paradigm. Participants high on 1 of these 3 dimensions and nonsymptomatic control participants viewed a series of affective pictures with acoustic startle probes presented before, during, and after the stimuli. All groups exhibited startle potentiation during unpleasant pictures and in anticipation of both pleasant and unpleasant pictures. Compared with control participants, symptomatic participants exhibited sustained potentiation following the offset of unpleasant stimuli and a lack of blink attenuation during and following pleasant stimuli. Common and unique patterns of affective responses in the 3 types of mood symptoms are discussed.     

The social phobia and anxiety inventory: Construct validity

The Social Phobia and Anxiety Inventory (SPAI) is a new instrument composed of social phobia and agoraphobia subscales. The latter scale is used to detect social anxiety that may result from agoraphobia. The SPAI's construct validity was assessed through several procedures. First, confirmatory factor analyses were conducted to validate the existence of the two subscales. Second, exploratory factor analyses examined the underlying structure of the social phobia subscale. Third, a Q factor procedure determined if different anxiety diagnostic groups could be differentiated by their SPAI response pattern. The results confirmed the utility of the two SPAI subscales and identified a number of dimensions contained within the social phobia subscale which differed depending upon the specific subject sample. In addition, the complaints of social phobies appeared more homogeneous than those of an agoraphobic comparison group. The results are discussed in terms of construct validity and the sensitivity of the SPAI to various dimensions of social phobia fears.This study was supported in part by NIMH Grants 41852, 30915, 18269, and 16884.     

Predicting response to anxiety management in patients with generalised anxiety disorders

This paper describes the analysis of predictive factors in a group of generally anxious patients treated with anxiety management. Evidence for three reliable predictors is presented. It is argued these reflect anxiety, demoralisation and depression. The same three variables contributed to prediction of outcome after treatment and 6 months later, and their pre-treatment values classified 80% of the patients correctly into good or poor responders. Lower initial levels of anxiety and demoralisation together with higher depression rated by the assessor predicted a better outcome. Predictions were more accurate for patients with a mild degree of depression than for those who were not depressed.     

Elevated disgust sensitivity in blood phobia

In order to demonstrate elevated disgust sensitivity and facilitated disgust learning in patients suffering from blood injection injury phobia, 23 phobics and 20 controls underwent an evaluative conditioning experiment. They were presented with picture pairs consisting of affectively neutral pictures (CS), which were followed by either disgust-inducing, fear-inducing, pleasant, or neutral scenes (US). During the presentation we recorded the electromyogram (EMG) of the musculus levator labii as a specific disgust indicator. Affective ratings for the pictures were determined before and after conditioning. Also, CS-US contingency verbalisation (CV) was assessed. Phobics reported a greater overall disgust sensitivity, experienced stronger feelings of disgust, and showed greater EMG responses while viewing disgust-eliciting scenes than control subjects. Evaluative conditioning occurred equally in both groups and depended on CV.     

The observer perspective: biased imagery in social phobia, agoraphobia, and blood/injury phobia.

Clark and Wells' (1995): 'A cognitive model of social phobia'. In Social phobia: Diagnosis, assessment, and treatment (pp. 69-93), R. G. Heimberg, M. R. Liebowitz, D. A. & F. R. Hope (eds.); cognitive model of social phobia proposes that social phobics generate a negative impression of how they appear to others. This impression often occurs in the form of an image from an "observer" perspective in which social phobics can see themselves as if from another person's vantage point. This study investigated the specificity of the observer perspective among patients with social phobia, agoraphobia, and blood/injury phobia. All participants were asked to recall and imagine a recent anxiety-provoking social situation and a non-social/non-anxiety-provoking situation, and rate their perspective for each. Consistent with predictions only patients with social-evaluative concerns (social phobics and agoraphobics) reported observer perspectives for anxiety-provoking social situations. Only social phobics showed a significant shift from an observer to a field perspective across the two conditions. The clinical implications of these findings are briefly discussed.     

Perception of control over anxiety mediates the relation between catastrophic thinking and social anxiety in social phobia

Cognitive models of social phobia (social anxiety disorder) assume that individuals with social phobia experience anxiety in social situations in part because they overestimate the social cost associated with a potentially negative outcome of a social interaction. Some emotion theorists, on the other hand, point to the perception of control over anxiety-related symptoms as a determinant of social anxiety. In order to examine the relationship between perceived emotional control (PEC), estimated social cost (ESC), and subjective anxiety, we compared three alternative structural equation models: Model 1 assumes that PEC and ESC independently predict social anxiety; Model 2 assumes that ESC partially mediates the relationship between PEC and anxiety, and Model 3 assumes that PEC partially mediates the relationship between ESC and anxiety. We recruited 144 participants with social phobia and administered self-report measures of estimated social cost, perceived anxiety control, and social anxiety. The results support Model 3 and suggest that "costly" social situations are anxiety provoking in part because social phobic individuals perceive their anxiety symptoms as being out of control.     

A multicomponent investigation of the interaction of generalized anxiety and phobia

Forty female undergraduates forming four groups, high or low trait anxiety with or without a specific fear (rats), participated in a psychophysiological assessment of their response to the phobic object, a neutral object (rabbit), and to a general anxiety-induction procedure (threat of shock). Subjects also completed a number of tasks requiring sustained attention. Blood samples were drawn to determine thyroid hormone (T3 and T4) levels. Trait anxiety was found to interact with specific fear in response to the feared object. The high-trait anxious/high-fear group was most physiologically responsive to the rat. Trait- anxious subjects were more responsive to the threat of shock and showed performance deficits on reaction time, vigilance, and backward digit span tasks. These subjects also had significantly higher T3 and T4 levels. The findings are discussed with regard to the role of general anxiety in the etiology and/or maintenance of specific fears and the role of thyroid hormones in accentuating physiological response to feared stimuli.