Cognitive restructuring treatment: A controlled trial with anxious patients

Cognitive restructuring, modified systematic desensitization and a combined treatment (cognitive behaviour modification) were compared with a no-treatment control group, using a simple randomized design. Twenty seven general anxiety out-patients selected from the hospital waiting list were used as subjects. Assessments were made at the beginning and end of treatment, and at follow-up 1 month later. The assessments included two subjective anxiety measures, the Zung self-rating anxiety scale and fear thermometer scores, a behavioural anxiety measure, a measure of cognitive anxiety as estimated by a diary recording of thinking time, fear survey schedule scores and I/E scores.Cognitive behaviour modification was found to be a superior form of treatment, relative to the no-treatment control and the other active treatment groups as assessed by FSS intensity score. The cognitive behaviour modification group showed greater improvement than the cognitive restructuring group on the diary anxiety scores. The results also demonstrated a relationship between outcome and initial severity of condition. The higher the subjects' initial scores on neurotic symptoms and subjective anxiety level, the greater the degree of positive change after treatment. Moreover, subjects with high levels of internal control prior to treatment responded most to therapy.     

中学生问题行为群体特征的多视角研究

以北京市中学生为被试,自编中学生问题行为自我评定、教师评定和家长评定三视角问卷,研究中学生问题行为的结构和群体特征,结果表明:(1)中学生问题行为评定存在跨评定者的六因子多质多法(multitrait—multimethod,MTMM)结构模型。(2)性别差异分析表明在学业不适、攻击行为和违纪行为上三视角均显示男生都显著高于女生,但是在内倾问题上自评问卷显示在神经质、退缩行为和考试焦虑上女生比男生高,教师评定只有在考试焦虑上女生高于男生,而家长评定内倾问题上性别差异基本不显著。(3)自评问卷在六因子和问题总分上还显示了年级差异,教师评定三个因子有年级差异,家长评定年级差异基本上不显著。(4)三视角对应因子间呈中低水平相关,在学业和破坏性较大的外倾问题上的相关高于在内倾问题上的相关。     

Career exploration in adolescents: The role of anxiety, attachment, and parenting style

The aim of the study was to examine the role of parent-adolescent attachment, adolescent anxiety and parenting style in the career exploration process and in career satisfaction. Three kinds of anxiety were considered: general trait anxiety, fear of failing in one’s career and fear of disappointing one’s parents. The participants were 283 French high school students on the threshold of one of the most important school transitions. The results varied by gender. For girls, general anxiety and neglectful style were negatively related to career exploration; secure attachment and fear of failing were positively related to it. For boys, fear of disappointing parents was positively related to career exploration. Attachment to parents, authoritative style, general anxiety, and fear of failing were related to some career exploration satisfaction scores, though differently for boys and girls. The differences between boys and girls in the roles played by anxiety, attachment and parenting style are discussed.     

Fear of fear,trait anxiety and aerobic fitness in relation to state anxiety during adrenalin provocation

Abstract

Psychological explanations of both spontaneous and experimentally induced panic anxiety stress the role of fear of fear, especially fear of bodily symptoms of arousal. Fear of fear is conceptually different from trait anxiety but may be associated with repeated experience of arousal symptoms in fearful situations, while frequent physical exercise may lead to habituation to these symptoms. To test this hypothesis, 44 healthy male volunteers, classified as having high or low trait anxiety and high or low aerobic fitness, underwent a single-dose adrenalin infusion (80 nanogram/kilogram bodyweight/minute). In both groups, during the experiment a significant rise in state anxiety was found; compared to the group with low trait anxiety, subjects with high trait anxiety reported higher levels of state anxiety, which could be attributed to differences in aerobic fitness. In the high-anxious group, subjects showed a greater decrease in state anxiety during the recovery phase. State anxiety during adrenalin was strongly associated with fear of bodily symptoms only in the high-anxious group. Correlations between trait anxiety and somatic anxiety were not significant; state anxiety scores tended to correlate negatively with physical fitness. It is concluded that these results lend support to a fear of fear-model of panic anxiety.     

The Roles of Shared Stereotypes and Shared Processing Goals on Mock Jury Decision Making

Some research on creativity has linked higher levels of neuroticism with greater creative achievement, whereas existential psychology sees the neurotic as incapable of channeling anxiety through creativity. The current research examines how levels of neuroticism affect individuals' creative responses in coping with existential threats. Drawing from terror management theory and creativity research, this research conceptualizes creative endeavors as a means to ameliorate existential anxiety that possesses varying degrees of appeal to different individuals. All three experiments found an interaction between levels of neuroticism and mortality salience in determining levels of creative interest, with neuroticism either measured or primed. Specifically, mortality salience is less likely to boost creative interest among more neurotic individuals.     

Fear and anxiety as separable emotions: an investigation of the revised reinforcement sensitivity theory of personality

The Gray and McNaughton (2000) theory draws on a wide range of animal data to hypothesize that the emotions of fear and anxiety are separable. The authors tested their hypothesis in two studies. The first study examined associations between scores on questionnaire measures of fear, anxiety, and neuroticism; correlational analysis revealed that fear and anxiety are not interchangeable constructs. The second study examined associations between scores on questionnaire measures of fear/anxiety and performance in a military training setting; regression analysis revealed that fear captured significant variance in performance that was not shared with anxiety. These results imply that hypotheses derived from nonhuman animal data may hold important implications for understanding human emotion and motivation, especially in relation to fear and anxiety.     

Fear of Pain is Elevated in Adults with Co‐Occurring Trauma‐Related Stress and Social Anxiety Symptoms

The aim of this study was to determine whether fear of pain and related fear constructs are elevated in people with co‐occurring trauma‐related stress and social anxiety symptoms relative to people with 1 or neither of these conditions. Eighty students were selected from a larger sample and divided into 4 equal groups comprising those with both high trauma‐related stress and social anxiety symptom scores (TRS/SAS), only high trauma‐related stress symptom scores (TRS), only high social anxiety symptom scores (SAS), or neither (N). Results indicated that the TRS/SAS group had significantly higher scores on all fear of pain measures, anxiety sensitivity, and illness/injury sensitivity than any other group, even when level of current pain was included as a covariate. These findings suggest that people with co‐occurring trauma‐related and social anxiety symptoms are most likely to be fearful of pain and to thereby be at increased risk of developing chronic and disabling pain. Implications for future research and treatment are discussed.     

Correlates of hypoglycemic fear in type I and type II diabetes mellitus.

We examined whether fear of hypoglycemia in insulin-dependent diabetes mellitus was associated with (a) higher levels of trait anxiety and general fearfulness, (b) difficulty in differentiating symptoms of anxiety and hypoglycemia, and (c) past experience with hypoglycemia. Joslin Diabetes Center outpatients with Type I and Type II diabetes (N = 232), all requiring insulin, were surveyed. Type I patients experienced significantly more fear of hypoglycemia than Type II patients. For the Type I and Type II groups, higher scores on the Worry subscale of the Hypoglycemia Fear Survey (HFS-W) were associated with higher levels of trait anxiety and fear. Higher scores on the Behavior subscale (HFS-B) were associated with higher levels of fear. Among Type I subjects only, HFS-W scores were also positively associated with past hypoglycemic experience and with difficulty in differentiating anxiety and hypoglycemic symptoms. These latter relations remained significant even after the variance resulting from trait anxiety and fear was removed. Other significant associations with HFS-B scores were not observed.     

Anxiety sensitivity and fear of pain in children

Associations among scores on scales of anxiety sensitivity and trait anxiety and a fear of pain questionnaire were examined for 118 children. Analysis showed that anxiety sensitivity was positively and substantially related to fear of pain in the children. Furthermore, the data suggested anxiety sensitivity to be a better predictor of fear of pain than trait anxiety.     

Factorial structure and MMPI correlates of a fear survey schedule in a clinical population

The Wolpe-Lazarus Fear Survey Schedule was administered in a neurotic population and factor analyzed. The largest factor (Tissue Damage/Medical) was uncorrelated with either the MAS or MMPI scales. However, total Fear Survey scores and Factor II (Interpersonal) showed a similar pattern of significant positive associations with both measures. The clinical relevance of global vs. part fear survey scores is discussed.     

Anxiety sensitivity within the anxiety disorders: disorder-specific sensitivities and depression comorbidity

The tendency to perceive anxious states as aversive and harmful is hypothesized to confer vulnerability to the development of anxiety disorders. The most commonly used measure of anxiety sensitivity, the Anxiety Sensitivity Index [ASI; Reiss, S., Peterson, R.A., Gursky, D.M., & McNally R.J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behavior Research and Therapy, 24, 1-8], is composed of multiple lower-order factors, assessing fear of physical symptoms, fear of publicly observable anxious symptoms, and fear of cognitive dyscontrol. This study examined the convergent validity of the lower-order anxiety sensitivity dimensions in DSM-IV diagnosed anxiety disorders. Participants with primary diagnoses of panic disorder with agoraphobia, social phobia, and generalized anxiety disorder (GAD) completed the ASI and measures of anxiety and depression severity. Support was found for the convergent validity of all ASI dimensions in reference to thematically related anxiety disorders and in the identification of patients presenting with and without secondary major depressive disorder (MDD). The ASI-fear of cognitive dyscontrol dimension displayed strong and nonredundant associations with GAD, dimensional depression scores, and secondary diagnoses of MDD. The conceptual implications of the shared importance of fear of cognitive dyscontrol in GAD and MDD are discussed.     

Manifest anxiety and fearfulness in children and adolescents.

The relationship between self-reported fear and anxiety was examined in a large sample of normal Australian children and adolescents. Participants completed the Fear Survey Schedule for Children--Revised (Ollendick, 1983) and the Revised Children's Manifest Anxiety Scale (Reynolds & Richmond, 1978). Following an examination of the internal consistency of these instruments, correlational analyses were conducted on anxiety and fear scores. Fear scores were shown to be sensitive to anxiety, sex, and age groups. Furthermore, discriminant analysis showed that high-anxiety children indicated a greater fear of items related to failure and criticism than did low-anxiety children. Other issues, including the content overlap between the two scales used in the investigation, are discussed.     

Strategic and Automatic Threat Processing in Chronic Musculoskeletal Pain: A Startle Probe Investigation

Attentional bias research with chronic pain samples has yielded conflicting results. In the present investigation the startle paradigm was used to test the postulate that fear‐based mechanisms play an important role in attentional biases for pain‐related threat in chronic pain. Participants, including 31 individuals with chronic musculoskeletal pain and 20 healthy controls, completed a startle task designed to measure attention to different types of words (neutral vs sensory pain vs affective pain vs health catastrophe) presented at different levels of cognitive processing (strategic vs automatic). Measures of fear‐based individual difference variables, including anxiety sensitivity and fear of pain, were also completed. Startle amplitudes and latencies to acoustic startle probes that followed word presentations were recorded. Data were analyzed with repeated measures ANOVAs and correlational analysis. Significant between‐group differences were found indicating that, relative to chronic pain participants, healthy controls had higher startle amplitude index scores for health catastrophe words. There was also a trend among patients with chronic pain for greater startle amplitude index scores for strategic presentations of sensory pain words. In the automatic condition, all participants demonstrated a lower startle latency index for sensory words relative to both affect and health catastrophe words, suggesting participants had more difficulty disengaging from affect and health catastrophe words or were more avoidant of sensory words. Correlational analyses indicated that startle response indices for words related to health catastrophe became more pronounced for chronic pain patients as anxiety sensitivity and fear of pain increased. Implications and directions for future research are discussed.     

An expanded childhood anxiety sensitivity index: its factor structure, reliability, and validity in a non-clinical adolescent sample

Anxiety sensitivity refers to the fear of anxiety-related bodily sensations that are interpreted as having potentially harmful somatic, psychological, or social consequences. The current study examined the factor analytic structure of anxiety sensitivity in a large sample of normal adolescents (N=518) using the revised childhood anxiety sensitivity index (CASI-R). Confirmatory factor analysis indicated that anxiety sensitivity as measured by the CASI-R can best be conceptualised as a hierarchical construct with four lower-order factors loading on a single higher-order factor. The lower-order factors were 'fear of cardiovascular symptoms', 'fear of publicly observable anxiety reactions', 'fear of cognitive dyscontrol', and 'fear of respiratory symptoms'. An additional aim of the present study was to investigate the psychometric properties of the CASI-R. Results showed the CASI-R to be a reliable scale in terms of internal consistency. Furthermore, CASI-R scores were substantially related to levels of anxiety sensitivity as measured by the original index, trait anxiety, symptoms of anxiety disorders, in particular 'panic disorder and agoraphobia', and depression. Finally, some evidence was found for the validity of the CASI-R factor scores. That is, all factors convincingly loaded on symptoms of 'panic disorder and agoraphobia', whereas the factor 'fear of publicly observable anxiety reactions' was also strongly associated with symptoms of 'social phobia'.     

The Eysenck personality scales: stability and change after therapy.

Eysenck has linked personality theory with the aetiology and treatment of abnormal behaviour (Eysenck, 1970). At least four levels of explanation link hypothetical neurophysiological mechanisms to self-report measures of personality, laboratory task performance and observed social habits and attitudes (Eysenck, 1960). The phenomena of neurotic breakdown and recovery provide one natural test of predictions from personality theory with respect to neuroticism (N) and extraversion (E). Taking phobias as an example, it is predicted that persons with a high score on N (a low threshold for emotional activation) develop phobic reactions more readily, and the more introverted the person, the more quickly and strongly are the phobic reactions acquired and lastingly maintained (Eysenck and Rachman, 1965, p. 36).In a prospective study of university students. Kelvin et al. (1965) were unable to find a relationship between initial N score and psychological distress up to 2.5 years later. Rather, the N scale appeared to reflect current mental status, increasing when distress was reported. E scores also dropped in a group of students who happened to be referred to a psychiatrist. Similarly, in a 3-year follow-up of patients who had attended a psychiatrist. Ingham (1966) found that change in clinical status was reflected in a change of N, with the score of the improved group returning to the population mean. Initial personality did not predict change in clinical status. It was also found in a number of analyses that improvement was related to an increase in extraversion.The present study was designed to replicate Ingham's experiment on a more homogeneous group of neurotic patients—all phobic—who had received fantasy or in vivo exposure treatment (Marks, 1974). This treatment can be compared to an extinction procedure, i.e. the non-reinforced presentation of the CS, and should therefore provide a good testing ground of personality theory. Eysenck's theory predicts that the speed and success of treatment will be related to initial E and N scores. In particular, the speed of extinction of the neurotic fear should be related to extraversion; the more extraverted the patient the more rapidly should the fear extinguish.     

The relationship between disgust sensitivity, anxiety and obsessions

Three hundred participants, including volunteers from an obsessional support group, filled in questionnaires relating to disgust sensitivity, health anxiety, anxiety, fear of death, fear of contamination and obsessionality as part of an investigation into the involvement of disgust sensitivity in types of obsessions. Overall, the data supported the hypothesis that a relationship does exist between disgust sensitivity and the targeted variables. A significant predictive relationship was found between disgust sensitivity and total scores on the obsessive compulsive inventory (OCI; Psychological Assessment 10 (1998) 206) for both frequency and distress of symptomatology. Disgust sensitivity scores were significantly related to health anxiety scores and general anxiety scores and to all the obsessional subscales, with the exception of hoarding. Additionally, multiple regression analyses revealed that disgust sensitivity may be more specifically related to washing compulsions: frequency of washing behaviour was best predicted by disgust sensitivity scores. Washing distress scores were best predicted by health anxiety scores, though disgust sensitivity entered in the second model. It is suggested that further research on the relationship between disgust sensitivity and obsessionality could be helpful in refining the theoretical understanding of obsessions.     

Determinants of early- vs late-onset dental fear in a longitudinal-epidemiological study.

A longitudinal investigation of risk factors for early- and late-onset dental fear was conducted. Early-onset dental fear was related to conditioning experiences (indexed via caries level and tooth loss), service use patterns, stress reactive personality and specific beliefs about health professionals. Late-onset dental fear was related to aversive conditioning experiences, irregular service use and an external locus of control. In contrast to recent findings for dental anxiety, personality factors were not strongly related to the onset of dental fear in young adulthood. The key role played by conditioning events in the development of both early- and late-onset dental fear was confirmed. Conditioning events appear to play a different role in the development of dental fear vs dental anxiety. This may reflect important, but largely ignored differences between these two closely-related constructs. Interventions for early-onset dental fear should aim to modify both the dental fear and the personality vulnerabilities that may contribute to the development of dental fear early in the life-course.     

Anxiety sensitivity, panic, and depressed mood: a reanalysis teasing apart the contributions of the two levels in the hierarchial structure of the Anxiety Sensitivity Index

Anxiety sensitivity (AS) has been defined as the fear of anxiety and anxiety-related sensations, and evidence suggests that AS plays an important role in the psychopathology of panic. It is entirely unclear whether the relation between AS and panic should be attributed to one (or more) of the AS group factors, the general AS factor, or to factors at both levels of the AS hierarchy. The authors reanalyzed data presented earlier by R. M. Rapee, T. A. Brown, M. A. Antony, and D. H. Barlow (1992) to tease apart the contributions of the different levels of the AS hierarchy to fear responses to hyperventilation and 5.5% carbon dioxide challenges. The results demonstrated that AS-Physical Concerns is the only one of the three AS group factors that contributes to relations with fear responses to these two challenges. However, AS-Mental Incapacitation Concerns had a stronger positive linear association with depressed mood than did AS-Physical Concerns.     

Fear of pain is elevated in adults with co-occurring trauma-related stress and social anxiety symptoms

The aim of this study was to determine whether fear of pain and related fear constructs are elevated in people with co-occurring trauma-related stress and social anxiety symptoms relative to people with 1 or neither of these conditions. Eighty students were selected from a larger sample and divided into 4 equal groups comprising those with both high trauma-related stress and social anxiety symptom scores (TRS/SAS), only high trauma-related stress symptom scores (TRS), only high social anxiety symptom scores (SAS), or neither (N). Results indicated that the TRS/SAS group had significantly higher scores on all fear of pain measures, anxiety sensitivity, and illness/injury sensitivity than any other group, even when level of current pain was included as a covariate. These findings suggest that people with co-occurring trauma-related and social anxiety symptoms are most likely to be fearful of pain and to thereby be at increased risk of developing chronic and disabling pain. Implications for future research and treatment are discussed.     

A psychometric reanalysis of the Albany Panic and Phobia Questionnaire

The psychometric properties of the 27-item Albany Panic and Phobia Questionnaire (APPQ) were evaluated in 1930 outpatients with DSM-IV anxiety and mood disorders. Although prior findings of a 3-factor latent structure were upheld in several replications (Social Phobia, Agoraphobia, Interoceptive), three items failed to load on their predicted factor (Interoceptive). Multiple-groups CFAs indicated that the measurement properties of the APPQ were invariant in male and female patients, with the exception of an intercept of one item from the Agoraphobia scale which evidenced bias against females. The three APPQ dimensions were consistently associated with high levels of scale reliability and factor determinacy. Strong evidence of concurrent validity of the Social Phobia and Agoraphobia factors was obtained in relation to interview and questionnaire measures. Although the Interoceptive factor was more strongly related to criterion measures of anxiety sensitivity and fear of panic than Social Phobia, the Agoraphobia factor had the strongest relationships with these validity indices. The results are discussed in regard to psychometric implications for the APPQ and conceptual issues pertaining to the discriminant validity of fear of agoraphobic situations and fear of sensation-producing activities.