Blood phobics and nonphobics: psychological differences and affect during exposure.

This study compared psychological dimensions of blood phobics and nonphobic controls, examined affect in response to phobic and neutral stimuli, and investigated the relationship between reported feelings of faintness and blood pressure. Blood phobics (24 adults with extreme Mutilation Questionnaire scores) and 24 nonphobics completed several psychological measures and viewed one of two 60 sec surgery scenes and a 60 sec neutral scene in counterbalanced order. Subjective, psychophysiologic, and motoric measures of affect were assessed. On questionnaires, phobics reported greater anxiety sensitivity, empathic distress, fear and insecurity, and nightmares, but no difference in autonomic arousal, muscle tension, motion sickness, or other empathy domains. During surgery scenes, phobics had more negative affect than controls; however, phobics were more anxious during only one of the two surgeries, and often only when the surgery was presented prior to the neutral scene. Fainting did not occur, and self-reported feelings of faintness were unrelated to blood pressure changes. The findings highlight the lack of information on blood phobic stimulus properties, fainting's relationship to self-reports and blood pressure, and the specific emotion experienced in blood phobia.     

Fear and Disgust Responding to Heterogeneous Blood-Injection-Injury Stimuli: Distinctions from Anxiety Symptoms

Discrepancies exist in the literature regarding the unique role of disgust in Blood-Injection-Injury (BII) phobia. The present study attempts to clarify the discrepancy using a sample of analogue BII phobics (n = 40) and nonphobics (n = 40) who completed a series of questionnaires and were exposed to blood, mutilation, and injection pictures. The findings revealed that BII phobics reported greater disgust and contamination fears than nonphobics after controlling for anxious symptoms. When rating phobia-relevant pictures, BII phobics responded with greater fear and disgust than nonphobics after controlling for baseline anxiety scores. Furthermore, disgust was the dominant emotional response for BII phobics for the blood and mutilation stimuli. However, no differences were found between fear and disgust within the BII group when rating injection stimuli. The implications of these findings for better understanding the potential unique role of disgust in the etiology, maintenance, and treatment of BII phobia are discussed.

Acquisition of blood, injury, and needle fears and phobias

The origins of fear and phobia of blood, injury, and injections were investigated in a sample of 128 fearful university students. Based on Mutilation Questionnaire scores, subjects were designated as common fear, high fear, or phobic. Ss reports of their onset experiences obtained from structured interviews were categorized into one or more acquisition pathways of conditioning, vicarious observation, and information. Of the 73% of Ss who recalled one or more onset experiences, 76% reported conditioning-like events as the primary pathway with the majority reporting fear-related UCSs. Vicarious experiences were reported as primary by 20% and 3% reported information as being primary in their fear onset. Severity of fear was unrelated to the pathway by which it was acquired, to whether the onset was recalled, and if recalled, whether it was due to a single or to multiple traumatic events. Results are discussed in terms of methodological problems of memory issues and means by which data are collected.     

The role of disgust propensity in blood-injection-injury phobia: Comparisons between Asian Americans and Caucasian Americans

There is a growing body of evidence suggesting the potential role of disgust propensity in blood-injection-injury (BII) phobia. The current study examined associations between disgust propensity and BII phobia symptom severity in Caucasian Americans (n=310) and Asian Americans (n=223). Asian Americans typically scored higher than Caucasian Americans on the BII and disgust measures. The present study also examined the structural relations between gender, cultural background, disgust propensity, and BII phobia symptom severity. According to the structural equation model, disgust propensity was significantly related to levels of BII phobia symptom severity and fully mediated the relationships between BII phobia symptom severity and the demographic variables of gender and cultural background. The implications of the results for cultural refinements to our understanding of disgust propensity and BII phobia are discussed.     

The Relations among Measurements of Informant Discrepancies within a Multisite Trial of Treatments for Childhood Social Phobia

Discrepancies between informants’ reports of children’s behavior are robustly observed in clinical child research and have important implications for interpreting the outcomes of controlled treatment trials. However, little is known about the basic psychometric properties of these discrepancies. This study examined the relation between parent-child reporting discrepancies on measures of child social phobia symptoms, administered before and after treatment for social phobia. Participants included a clinic sample of 81 children (7–16 years old [M = 11.75, SD = 2.57]; 39 girls, 42 boys) and their parents receiving treatment as part of a multisite controlled trial. Pretreatment parent-child reporting discrepancies predicted parent-child discrepancies at posttreatment, and these relations were not better accounted for by the severity of the child’s pretreatment primary diagnosis. Further, treatment responder status moderated this relation: Significant relations were identified for treatment non-responders and not for treatment responders. Overall, findings suggest that informant discrepancies can be reliably employed to measure individual differences over the course of controlled treatment trials. These data provide additional empirical support for recent work suggesting that informant discrepancies can meaningfully inform understanding of treatment response as well as variability in treatment outcomes.     

Psychometric properties and factor structure of the Fear Questionnaire phobia subscale items in two normative samples

Normative data for the Fear Questionnaire (Marks & Mathews, 1979), a popular self-report instrument measuring phobic concerns, were collected from both a community and a collegiate sample. The covariation and internal consistency of the blood-injury phobia (BI), social phobia (SO), and agoraphobia (AG) subscales were assessed in each sample, and the factor structure of the items from these three subscales was examined. Results indicated that, in general, community subjects reported more phobic concerns than did collegiate subjects, and females reported greater phobic concerns than did males. Results from confirmatory factor analyses suggest that the three factors of BI, SO, and AG did not emerge from either data set. Follow-up exploratory factor analyses did identify the general factors of blood-injury phobia and agoraphobia. Normative data from the present study are compared to those obtained previously, and directions for future research are provided.     

Disgust sensitivity and contamination fears in spider and blood-injection-injury phobias

Disgust has been implicated in the onset and maintenance of blood-injection-injury (BII) and animal phobias. Research suggests that people with these phobias are characterized by an elevated sensitivity to disgust-evoking stimuli separate from their phobic concerns. The disgust response has been described as the rejection of potential contaminants. Disgust-motivated avoidance of phobic stimuli may therefore be related to fears of contamination or infection. The present study compared BII phobics, spider phobics and nonphobics on two measures of disgust sensitivity and two measures of contamination fears. Positive correlations were found between disgust sensitivity and contamination fear. Specific phobics scored higher than nonphobics on all scales and BII phobics scored higher than spider phobics on contamination fear measures. Furthermore, the contamination fear scales were correlated with the blood phobia measure, but not correlated with the spider phobia measure. The results suggest that while both phobias are characterized by elevated disgust sensitivity, contamination fear is more prominent in BII than spider phobia.     

I am going to gag: Disgust cognitions in spider and blood-injury-injection fears

There is mounting evidence that disgust plays an important role in certain anxiety disorders, yet little is known about disgust's cognitive component. The current study introduces a measure of cognitions associated with disgust and contamination to assess the role of disgust-specific primary and secondary appraisals in phobic responding. A multi-modal assessment of blood-injury-injection (BII) and spider phobia was conducted using BII (N=29) and spider (N=30) fearful groups, and a non-fearful control group (N=30). The Disgust Cognitions scale showed good reliability and validity, and distinguished among the groups. For example, relative to the other groups, the spider fear group reported higher disgust cognitions following presentation of a live spider, whereas the BII Fear group reported higher disgust cognitions following a surgery video. Moreover, the scale was associated with multiple phobic indicators (behavioral avoidance, subjective distress, symptom endorsement), suggesting cognitions may be critical to understanding how disgust contributes to anxiety disorders.     

I am going to gag: Disgust cognitions in spider and blood–injury–injection fears

There is mounting evidence that disgust plays an important role in certain anxiety disorders, yet little is known about disgust's cognitive component. The current study introduces a measure of cognitions associated with disgust and contamination to assess the role of disgust-specific primary and secondary appraisals in phobic responding. A multi-modal assessment of blood–injury–injection (BII) and spider phobia was conducted using BII (N=29) and spider (N=30) fearful groups, and a non-fearful control group (N=30). The Disgust Cognitions scale showed good reliability and validity, and distinguished among the groups. For example, relative to the other groups, the spider fear group reported higher disgust cognitions following presentation of a live spider, whereas the BII Fear group reported higher disgust cognitions following a surgery video. Moreover, the scale was associated with multiple phobic indicators (behavioural avoidance, subjective distress, symptom endorsement), suggesting cognitions may be critical to understanding how disgust contributes to anxiety disorders.     

The role of disgust propensity in blood-injection-injury phobia: comparisons between Asian Americans and Caucasian Americans

There is a growing body of evidence suggesting the potential role of disgust propensity in blood-injection-injury (BII) phobia. The current study examined associations between disgust propensity and BII phobia symptom severity in Caucasian Americans (n=310) and Asian Americans (n=223). Asian Americans typically scored higher than Caucasian Americans on the BII and disgust measures. The present study also examined the structural relations between gender, cultural background, disgust propensity, and BII phobia symptom severity. According to the structural equation model, disgust propensity was significantly related to levels of BII phobia symptom severity and fully mediated the relationships between BII phobia symptom severity and the demographic variables of gender and cultural background. The implications of the results for cultural refinements to our understanding of disgust propensity and BII phobia are discussed.     

Anxiety in Children with Mood Disorders: A Treatment Help or Hindrance?

This study examined the role of comorbid anxiety in treatment outcome for children with mood disorders (N = 165; age 8–11) participating in Multi-Family Psychoeducational Psychotherapy (MF-PEP). Assessments occurred at baseline, 6, 12, and 18 months for two randomly assigned groups: immediate treatment and 1-year wait-list. Most children (69%) had comorbid anxiety disorders. Baseline comorbid anxiety, as reported on the Children’s Interview for Psychiatric Syndromes (ChIPS), was associated with higher Children’s Depression Rating Scale- Revised (CDRS-R) scores but not Young Mania Rating Scale (YMRS) scores. Higher levels of anxiety symptoms were associated with lower Children’s Global Assessment Scale (C-GAS) scores. Participation in MF-PEP did not significantly reduce anxiety symptoms (p = 0.62). However, presence of comorbid anxiety did not impede reduction in depressive (CDRS-R, p = 0.74) or manic (YMRS scores, p = 0.94) symptoms following MF-PEP. More baseline anxiety symptoms were associated with greater improvement in C-GAS scores post-treatment (p = 0.02). Implications are discussed.     

Psychometric Characteristics of the Beck Self-Concept Inventory for Youth with Adolescents Who Have Experienced Sexual Abuse

The Beck Self-Concept Inventory for Youth (BYI-S; Beck et al. in Manual for the Beck Youth Inventories of Emotional and Social Impairment, 2001) was administered to 100 adolescents (12–17 years old) who experienced sexual abuse. An iterated principal-factor analysis found that the BYI-S represented two highly correlated (r = .53) factors corresponding to the Self-Esteem and Competency dimensions that Steer, Kumar, Beck, and Beck (J Psychopathol Behav Assess 27:123–131, 2005) found with child psychiatric outpatients. Item analyses were used to derive two six-item subscales measuring Self-Esteem and Competency that had coefficient αs > .80. The Self-Concept total and subscale scores were differentially correlated with various psychosocial characteristics of the youth. Low Self-Esteem scores were associated with total number of posttraumatic symptoms and self-reported anger, whereas low Competency scores were related to externalizing behavior problems. The BYI-S was discussed as being a useful instrument for assessing the self-concepts of youth who have experienced sexual abuse.     

Reliability,Validity and Invariance of the Narcissistic Personality Questionnaire for Children-Revised (NPQC-R)

Using confirmatory factor analysis, this study compared the 4-factor 18-item Narcissistic Personality Questionnaire for Children (NPQC) and the 2-factor, 12-item Narcissistic Personality Questionnaire for Children-Revised (NPQC-R). Support was found for the 2-factor structure of the 12-item NPQC-R using two independent adolescent school-based samples (n = 479 and n = 470). The 2-factor NPQC-R model (i.e., Superiority, Exploitativeness) showed a better fit in both adolescent samples than the alternative 4-factor NPQC model. There was strong support for NPQC-R’s invariance across gender and age. The NPQC-R was found to have reasonable internal consistency estimates, test–retest reliability estimates, and adequate convergent and discriminant validity estimates. Collectively, these results support the utility of the NPQC-R as a measure of narcissism in children and adolescents. A copy of the NPQC-R and scoring key can be obtained from Rebecca P. Ang.     

Exposure to disgust-evoking imagery and information processing biases in blood-injection-injury phobia

Biased processing of threat-relevant information is a central construct among contemporary theories of anxiety. However, biases in attentional and memory processes have not been systematically investigated in blood-injection-injury (BII) phobia. Theory has suggested that disgust rather than fear characterizes BII phobia and may mediate processing biases differently. We investigated the effects of a disgust mood induction on attention and memory in BII phobic and nonphobic participants. The Stroop task failed to demonstrate an attentional bias toward medical and disgust words, even under conditions of disgust provocation. However, an implicit memory task showed that BII phobics completed more medical and disgust word stems than nonphobics. These results suggest that BII phobia may be characterized by a similar implicit memory, but not an attentional, bias found in other anxiety disorders. As such, information processing in BII phobia may be qualitatively different from other anxiety disorders. Implications for further research regarding information processing biases in BII phobia are discussed.     

Emotional Intelligence in Social Phobia and Other Anxiety Disorders

This study examined the associations between clinical anxiety, domains of emotional intelligence (EI), and three clinician-rated indices of maladjustment. Of key interest was whether social phobia (SP) is unique among anxiety disorders in being characterized by lower levels of Interpersonal and, particularly, Intrapersonal EI, and whether these differentially predict maladjustment. Individuals with SP (n = 169) obsessive-compulsive disorder (n = 65) and panic disorder (n = 64), and nonclinical controls (n = 169) completed the short form self-report Emotional Quotient Inventory (EQ-i: S). All anxiety disorder groups showed lower total EI than controls, and differed among themselves with the SP group displaying the lowest levels of total EI and lower scores on two EQ-i:S subscales (Interpersonal and, more robustly, Intrapersonal). The Intrapersonal dimension alone predicted all indices of greater maladjustment in the SP group. These findings indicate a negative relationship between anxiety disorders and EI, and reaffirm the foremost link between Intrapersonal EI and SP and its functional outcomes.     

Screening for Eating Disorders in Undergraduate Women: Norms and Validity of the Spanish Version of the Eating Disorder Examination Questionnaire (EDE-Q)

The purpose of this investigation was to examine the internal consistency reliability and the convergent validity of the Spanish version of the Eating Disorder Examination Questionnaire (EDE-Q) and to provide EDE-Q norms for Spanish undergraduate women. Seven hundred eight college women, aged 18–30 years, volunteered to complete the EDE-Q, BSQ and EDI-2. Satisfactory internal consistency for the four subscales and the global score of the EDE-Q was obtained (Cronbach’s α ≥ .81). The EDI-2 Drive for Thinness and Body Dissatisfaction subscales and the BSQ global factor score correlated highly and positively with the corresponding EDE-Q subscales (r ≥ .72). Average scores, standard deviations and percentile ranks for the raw EDE-Q subscales and data on the occurrence of binge eating and compensatory behaviors are presented. Most of these values were lower than those found in other non-European developed countries. Results support the satisfactory internal consistency and convergent validity of the Spanish version of the EDE-Q. Lower scores in EDE-Q subscales suggest the need to study a lower cut-off point for clinical significance in Spanish college women. These data will help clinicians and researchers to interpret the EDE-Q scores of college women in Spain.     

Emotion Regulation of Others and Self (EROS): The Development and Validation of a New Individual Difference Measure

Research on affect regulation has blossomed in recent years. However, the lack of validated scales assessing individual differences in the use of strategies to achieve alternative types of affect regulation, e.g., the regulation of others’ affect and the worsening of affect, has hampered research on these important processes. This paper presents the development and validation of a brief new measure of individual differences in the use of strategies to regulate one’s own and other people’s feelings: the Emotion Regulation of Others and Self (EROS) scale. Two distinct samples (N = 551 and N = 227) confirmed a four-factor structure: intrinsic affect-improving, intrinsic affect-worsening, extrinsic affect-improving and extrinsic affect-worsening. In line with predictions, these factors were associated with existing measures of affect regulation, personality and affect. Both intrinsic factors were positively associated with emotional exhaustion, while all factors except extrinsic affect-improving were positively associated with health-related impairments. Convergence between self- and other-reported scores on the extrinsic factors in a third sample (N = 50 dyads) demonstrated further evidence of validity.     

Reward and Punishment Sensitivity in Children with ADHD: Validating the Sensitivity to Punishment and Sensitivity to Reward Questionnaire for Children (SPSRQ-C)

This study validates the Sensitivity to Punishment and Sensitivity to Reward Questionnaire for children (SPSRQ-C), using a Dutch sample of 1234 children between 6–13 years old. Factor analysis determined that a 4-factor and a 5-factor solution were best fitting, explaining 41% and 50% of the variance respectively. The 4-factor model was highly similar to the original SPSRQ factors found in adults (Punishment Sensitivity, Reward Responsivity, Impulsivity/Fun-Seeking, and Drive). The 5-factor model was similar to the 4-factor model, with the exception of a subdivision of the Punishment Sensitivity factor into a factor with ‘social-fear’ items and a factor with ‘anxiety’ items. To determine external validity, scores of three groups of children with attention deficit hyperactivity disorder (ADHD) were compared on the EFA models: ADHD-only (n = 34), ADHD and autism spectrum disorder (ADHD+ASD; n = 22), ADHD and oppositional defiant disorder (ADHD+ODD; n = 22). All ADHD groups scored higher than typical controls on Reward Responsivity and on the ‘anxiety’ factor (n = 75). The ADHD-only and ADHD+ODD group scored higher than other groups on Impulsivity/Fun-Seeking and Drive, while the ADHD+ASD group scored higher on Punishment Sensitivity. The findings emphasize the value of the SPSRQ-C to quickly and reliably assess a child’s sensitivity to reinforcement, with the aim to provide individually-tailored behavioral interventions that utilize reward and reprimands.     

When to Use Broader Internalising and Externalising Subscales Instead of the Hypothesised Five Subscales on the Strengths and Difficulties Questionnaire (SDQ): Data from British Parents,Teachers and Children

The Strengths and Difficulties Questionnaire (SDQ) is a widely used child mental health questionnaire with five hypothesised subscales. There is theoretical and preliminary empirical support for combining the SDQ’s hypothesised emotional and peer subscales into an ‘internalizing’ subscale and the hypothesised behavioral and hyperactivity subscales into an ‘externalizing’ subscale (alongside the fifth prosocial subscale). We examine this using parent, teacher and youth SDQ data from a representative sample of 5–16 year olds in Britain (N = 18,222). Factor analyses generally supported second-order internalizing and externalizing factors, and the internalizing and externalizing subscales showed good convergent and discriminant validity across informants and with respect to clinical disorder. By contrast, discriminant validity was poorer between the emotional and peer subscales and between the behavioral, hyperactivity and prosocial subscales. This applied particularly to children with low scores on those subscales. We conclude that there are advantages to using the broader internalizing and externalizing SDQ subscales for analyses in low-risk samples, while retaining all five subscales when screening for disorder.     

Mindfulness and the Attenuation of Post-Event Processing in Social Phobia: An Experimental Investigation

The present experimental study examined the ability of metacognitive strategies to reduce the distress associated with post-event processing (PEP). Individuals with DSM-IV generalized social phobia (N = 57) were randomly allocated to receive brief training in mindfulness, distraction, or no training (control group). Next, they underwent an experimental PEP induction. Following the induction, they were instructed to apply the metacognitive strategy (mindfulness or distraction) they were taught or to continue thinking about the social event the way they typically would following such an event (control). Participants rated their distress on a visual analogue scale prior to the PEP induction, and then every minute for 5 min while applying the metacognitive strategy. They also rated their affect immediately after applying the metacognitive strategy. Results suggest that mindfulness reduces distress significantly over the post-event period and results in significantly more positive affect than when receiving no training. In contrast, distraction does not reduce distress over the post-event period performs comparable to receiving no training. The results of this experimental investigation suggest that mindfulness has the potential to reduce distress associated with PEP and provide further support for the clinical utility of mindfulness in the treatment of generalized social phobia.