A preliminary study of the emotion understanding of youths referred for treatment of anxiety disorders

Examined the emotion understanding of children and adolescents referred for treatment of Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) anxiety disorders (separation anxiety disorder, generalized anxiety disorder, or social phobia). Referred youths (n = 17) and nonreferred youths (n = 21) and their parents participated by completing self-report and parent-report questionnaires and structured diagnostic interviews. We interviewed all youths by using an emotion understanding interview. Referred youths demonstrated poorer understanding of hiding emotions and changing emotions compared with nonreferred youth. The 2 groups were not significantly different regarding their understanding of emotion cues and multiple emotions, however. No statistically significant relation emerged between general intelligence and emotion understanding. Future research directions are discussed.     

DSM-defined anxiety disorders symptoms in South African youths: Their assessment and relationship with perceived parental rearing behaviors

This study investigated DSM-defined anxiety symptoms in South African youths. Children and adolescents (N = 701) from various cultural groups completed the SCARED and a questionnaire measuring perceived parental rearing behaviors. Results indicated that the psychometric properties of the SCARED were satisfactory in the total sample of South African youths, and acceptable in colored and black children and adolescents. Further, colored and black youths displayed higher SCARED scores than white youths, and there were also differences in the perceived parental rearing behaviors of the cultural groups. White youths generally rated their parents' rearing behaviors as less anxious, overprotective, and rejective, but more emotionally warm than colored and black youths. Finally, positive correlations were found between anxious rearing, overprotection, and rejection and anxiety symptoms. The clinical and research implications of these findings are briefly discussed.     

A maintenance program for behavioral treatment of anxiety disorders

A maintenance program for behavioral treatments of anxiety disorders is presented in some detail, together with preliminary results of its application as part of three treatment trials. Compared to previous studies reporting long-term effects of behavioral treatments, the present program yielded a larger percentage of improvement during the follow-up period, a lower proportion of patients needing further treatment, and fewer relapses.     

The relationship between comorbid personality disorders and treatment received in patients with anxiety disorders

Few studies have addressed the relationship between the presence of a comorbid personality disorder and the amount of psychiatric treatment received by patients with an Axis I disorder. This issue has not been studied in patients with anxiety disorders. In a prospective, naturalistic, longitudinal study of anxiety disorders, 526 subjects were assessed with the Personality Disorder Examination, and types of treatment received in 1991 and 1996 were identified. In 1991, compared to subjects without a personality disorder, subjects with a personality disorder were as likely to receive medication and they received a greater number of medications. Subjects with borderline personality disorder were more likely to receive heterocyclic antidepressants and interventions characteristic of psychodynamic psychotherapy and cognitive therapy; they also reported receiving a greater number of medications and types of psychosocial treatment than other subjects. In 1996, subjects with borderline personality disorder were more likely to receive psychodynamic interventions. These findings suggest that in patients with an anxiety disorder, the presence of a comorbid personality disorder is associated with receiving a greater number of medications but not with a greater likelihood of receiving pharmacologic or psychosocial treatment. However, the presence of borderline personality disorder is associated with a greater likelihood of receiving, and receiving a greater number of, certain types of somatic and psychosocial treatments.     

Distinguishing youths at risk for anxiety disorders from self‐reported BIS sensitivity and its psychophysiological concomitants

The aim of the study was to explore the psychophysiological concomitants of self‐reported behavioral inhibition system (BIS) sensitivity in adolescents (12 to 17 years old) supposed to be at risk for anxiety disorders. Twenty participants with high scores in self‐reported BIS sensitivity (at‐risk group) were matched in age and sex to 20 participants scoring in the normal range in BIS sensitivity (control group). Negative affect, negative emotion regulation style, and anxiety symptomatology were assessed by means of self‐reported measures. Cardiac and electrodermal response signals were recorded during baseline, paced breathing, exposure to an attentional task with response cost and fear‐relevant slides conditions. The at‐risk group exhibited higher scores on measures of negative affect, negative emotion regulation style, and anxiety symptomatology than their control counterparts. After controlling for negative styles of emotion regulation, groups did not differ in skin conductance reactivity during the attentional task with response cost, but participants at risk exhibited more nonspecific skin conductance responses than the control group during baseline recording. Regarding the cardiac concomitants, participants at risk presented lower vagal tone at resting conditions as compared to participants in the control group. Additionally, at‐risk participants exhibited lower flexibility across experimental conditions in heart rate and cardiac sample entropy measures than participants in the control group. These findings add knowledge on psychophysiological concomitants of BIS sensitivity and are discussed in light of associations between temperament and development of anxiety disorders in youth. They show how psychophysiological patterns observed in resting conditions could be useful endophenotypes to reliably detect individuals at risk before the disorder onset.     

The influence of comorbidity on treatment outcome for children and adolescents with anxiety disorders

There have been a growing number of studies showing that cognitive behavioural treatment packages for children with anxiety disorders are highly effective. Clinically, it is often assumed that treatment outcome is less successful, or that treatment needs to be altered when faced with the existence of comorbid conditions. To date, only one study has directly addressed this question in the child anxiety literature. The present study compared the treatment outcome and maintenance following a brief, group program for the reduction of child and adolescent anxiety disorders in anxious children with versus without comorbid disorders. There was no significant difference in response to treatment at the end of the program and few differences at 12-month follow-up. The only indication of an impact of comorbidity was a suggestion that children with a comorbid condition did not do as well at follow-up. However, this result was only shown on some parent-report measures and not on self-report measures. Overall, the results indicate that treatment for child and adolescent anxiety disorders produces broadly comparable results regardless of the existence of comorbid disorders.     

Types of self-reported anxiety in outpatients with DSM-III-R anxiety disorders1

To ascertain whether psychiatric outpatients can be classified into distinct types according to their self-reported symptoms of anxiety, the Beck Anxiety Inventory (BAI) was administered to 655 outpatients diagnosed with DSM-III-R anxiety disorders. Cluster analysis identified three internally consistent subscales representing subjective, somatic, and panic symptoms. Further analysis revealed six types of outpatients reflecting below average, panic-subjective, low subjective, low somatic-panic, above average, and subjective-somatic anxiety. The types were differentiated with respect to age, primary diagnosis, clinically rated anxiety, and both self-reported and clinically rated depression.     

Memory bias for threatening information in anxiety and anxiety disorders: a meta-analytic review

Although some theories suggest that anxious individuals selectively remember threatening stimuli, findings remain contradictory despite a considerable amount of research. A quantitative integration of 165 studies with 9,046 participants (clinical and nonclinical samples) examined whether a memory bias exists and which moderator variables influence its magnitude. Implicit memory bias was investigated in lexical decision/stimulus identification and word-stem completion paradigms; explicit memory bias was investigated in recognition and recall paradigms. Overall, effect sizes showed no significant impact of anxiety on implicit memory and recognition. Analyses indicated a memory bias for recall, whose magnitude depended on experimental study procedures like the encoding procedure or retention interval. Anxiety influenced recollection of previous experiences; anxious individuals favored threat-related information. Across all paradigms, clinical status was not significantly linked to effect sizes, indicating no qualitative difference in information processing between anxiety patients and high-anxious persons. The large discrepancy between study effects in recall and recognition indicates that future research is needed to identify moderator variables for avoidant and preferred remembering.     

Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial

Clinician-guided Internet-based cognitive behavioural therapy (iCBT) programs are clinically effective at treating specific anxiety disorders. The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment (iCBT) program to treat more than one anxiety disorder within the same program (the Anxiety Program). Eighty six individuals meeting diagnostic criteria for generalized anxiety disorder (GAD), panic disorder, and/or social phobia were randomly assigned to a treatment group, or to a waitlist control group. Treatment consisted of CBT based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. An intention-to-treat model using the baseline-observation-carried-forward principle was employed for data analyses. Seventy-five percent of treatment group participants completed all 6 lessons within the 8 week program. Post-treatment data was collected from 38/40 treatment group and 38/38 control group participants, and 3-month follow-up data was collected from 32/40 treatment group participants. Relative to controls, treatment group participants reported significantly reduced symptoms of anxiety as measured by the Generalized Anxiety Disorder - 7 Item, Social Phobia Screening Questionnaire, and the Panic Disorder Severity Rating Scale - Self Report Scale, but not on the Penn State Worry Questionnaire, with corresponding between-groups effect sizes (Cohen’s d) at post-treatment of 0.78, 0.43, 0.43, and 0.20, respectively. The clinician spent a total mean time of 46 min per person over the program, participants rated the procedure as moderately acceptable, and gains were sustained at follow-up. Modifications to the Anxiety program, based on post-treatment feedback from treatment group participants, were associated with improved outcomes in the control group. These results indicate that transdiagnostic programs for anxiety disorders may be successfully administered via the Internet.     

Parenting behaviors in parents with anxiety disorders

Anxiety disorders are familial, and although considerable evidence supports the role of genetic/biological parameters in their development, these alone do not entirely explain their etiology. In this study, the role of parenting behavior as a possible factor in the transmission of anxiety from parent to child was examined. Using interview, self-report, and direct behavioral observation, behaviors of parents with an anxiety disorder were compared to those of parents without an anxiety disorder on a number of dimensions, but particularly with respect to whether anxious parents actively inhibited their children from engaging in normal age appropriate activities. These behaviors were assessed during routine activities and in a structured non-conflictual play task. Although anxious parents did not overtly restrict their child's behavior in either type of activity, they reported higher levels of distress when their children were engaged in these activities. Similarly, the "emotional climate" in families with an anxious parent differed significantly from families without an anxious parent. The results are discussed in terms of how parenting behaviors might influence the development of maladaptive anxiety via social learning and information transfer, and their heuristic implications.     

Resting autonomic activity in adults who stutter and its association with self-reports of social anxiety

PurposeThe purpose of this study was to investigate resting autonomic activity in adults who stutter (AWS) compared to adults who do not stutter (ANS) and the relationship this has on self-reports of social anxiety.MethodsThirteen AWS and 15 ANS completed the Social Interaction Anxiety Scale (SIAS; Mattick & Clark, 1998) and Brief Fear of Negative Evaluation (BFNE; Leary, 1983). Following this, measures of skin conductance levels (i.e. index of sympathetic activity) and respiratory sinus arrhythmia (i.e. index of parasympathetic activity) were taken during a 5-minute resting, baseline period. Independent sample t tests were used to assess differences between groups on self-reports of anxiety (SIAS, BFNE) and resting autonomic levels (SCL, RSA). Separate multiple regression analyses were performed in order to assess the relationship between self-reports of anxiety and autonomic measures.ResultsResults showed significantly higher mean SCL and lower mean RSA levels in the AWS compared to the ANS at resting, baseline. Regression analysis showed that self-reports from the SIAS had a significant effect on RSA levels for the AWS but not the ANS. No significant effects were found for BFNE on RSA. Nor was there a significant effect from SIAS or BFNE on SCL levels for either group.ConclusionFindings suggest that resting RSA levels may be a physiological marker for social anxiety levels in adults who stutter.     

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.     

Evaluation of manual-based cognitive-behavioral therapy for bulimia nervosa in a service setting

In the present study manual-based cognitive-behavioral therapy for bulimia nervosa was evaluated on an unselected sample of an out-patient service facility. A total of 73 female patients who asked for treatment received the primary diagnosis of bulimia nervosa. Of these, 67 took up treatment. Treatment was completed by 66 patients. Outcome variables were the number of binge episodes along with questionnaire scores for restraint eating, emotional eating, body dissatisfaction and depressiveness. At the end of treatment and 1 year after the end of treatment significant improvements were found in all outcome variables. Effect sizes for outcome variables were within the range of those of controlled research. Therefore, the present study delivered empirical evidence that manual-based cognitive-behavioral therapy is an effective treatment for bulimia nervosa not only within the restricted area of research.     

Effects of perceived criticism on anxiety and depression during behavioral treatment of anxiety disorders

The present study explored the effect of perceived criticism (PC) on levels of anxiety and depression during behavioral treatment among patients diagnosed with obsessive-compulsive disorder (OCD) or panic disorder with agoraphobia (PDA). We posited that patients' perceptions of relatives' criticism and the degree to which they were upset by the criticism (UC) would be related to negative affect and discomfort during exposure. The sample included 75 patients with a primary diagnosis of OCD (n=43) or PDA (n=32) and their participating relatives. Measures of patients' weekly ratings of PC and upset about the criticism, anxious and depressed mood, and subjective discomfort during exposure treatment were analyzed using a mixed model regression approach (SAS Proc Mixed). Patients' anxious and depressed mood predicted greater discomfort during exposure. Patients who were more UC also had higher weekly ratings of anxiety and depression, and more discomfort during exposure sessions. Findings suggest that treatment outcome may be improved by attention to patients' reactions to their interpersonal environment.     

Interrelationships between anxiety,lifestyle self-reports and fitness in a sample of Hong Kong University students

Although anxiety in university students has been well documented, the influence of lifestyle and fitness status in relation to anxiety has not been investigated from a cultural perspective previously. To make recommendations regarding the avoidance or management of anxiety in this anxiety-prone cohort that are rationally based, this preliminary investigation examined the interrelationship between anxiety, lifestyle self-reports and aerobic fitness in Hong Kong Chinese University students. The State Trait Anxiety Inventory (Form Y-2) and a lifestyle questionnaire were completed by 213 students. Female students were more anxious than male students. Subjects with high anxiety reported more deleterious lifestyle behaviours including higher salt consumption and lower levels of exercise; in addition to more frequent symptoms of anxiety such as headaches and daytime somnolence. The extremes of this sample were stratified into a low anxiety group (n = 17) and a high anxiety group (n = 14) to compare their fitness status. Although both groups had below normal aerobic capacity, the higher systolic blood pressure observed for the high anxiety group is consistent with signs of anxiety, or greater deconditioning in this group or both. The results of this study have highlighted anxiety as a concern in Hong Kong University students and identified some lifestyle and fitness correlates. Understanding lifestyle and pathophysiological correlates of anxiety in Hong Kong University students that may have a cultural basis, is a crucial step toward averting or managing anxiety when these students are studying either in Hong Kong or abroad.