Exposure and communications training in the treatment of agoraphobia

Twenty-one agoraphobics participated in a 6-month study designed to (a) compare imaginal flooding under high- (no sedation) and low- (sedation used) anxiety conditions: (b) examine the long-term effects of imaginal flooding in the absence of further exposure treatment; and (c) explore the impact of communications training on chronic anxiety and panic attacks. A reevaluation of the effects of sedation is presented in this report.Imaginal flooding without sedation was, on the whole, superior to the attention control placebo and imaginal flooding with sedation on therapists' and clients' ratings of fear and avoidance. However, the superiority of the non-drug flooding group cannot be attributed (as was concluded in an earlier report) to higher levels of anxiety across flooding sessions. Rather the drug (methohexitone sodium) appears to have impeded across-session habituation, perhaps by interfering with long-term memorial processes.The effects of imaginal flooding without sedation were stable over 4 months without further exposure treatment. These clients did receive training in solving important interpersonal problems through self monitoring and increased expressiveness. Contrary to hypotheses, not only was no further improvement obtained on fear and avoidance with this treatment, but also anxious mood and panic attacks remained unaffected. It is surprising to note that in-vivo treatment was no more effective than imaginal flooding on fear and avoidance. These and other findings suggest imaginal flooding well warrants further study.     

Physiological and subjective measures of anxiety during flooding

Patterns of physiological arousal and subjective reports of anxiety were examined during individual sessions of imaginal flooding of five phobic subjects. A curvilinear pattern of increased, followed by decreased, arousal characterized changes in heart rate, respiration rate and subjective anxiety. Heart rate tended to reach its peak level before respiration rate and subjective anxiety. Intercorrelations between these measures were generally positive and significant. Comparisons between periods of high and low subjective arousal revealed a significantly greater correlation for low than for high arousal only for the subjective anxiety by respiration-rate correlation.     

Emotional avoidance: an experimental test of individual differences and response suppression using biological challenge

The present study examined the affective consequences of response inhibition during a state of anxiety-related physical stress. Forty-eight non-clinical participants were selected on the basis of pre-experimental differences in emotional avoidance (high versus low) and subjected to four inhalations of 20% carbon dioxide-enriched air. Half of the participants were instructed to inhibit the challenge-induced aversive emotional state, whereas the other half was instructed to simply observe their emotional response. Participants high in emotional avoidance compared to those low in emotional avoidance responded with greater levels of anxiety and affective distress but not physiological arousal. Individuals high in emotional avoidance also reported greater levels of anxiety relative to the low emotional avoidance group when suppressing compared to observing bodily sensations. These findings are discussed in terms of the significance of emotional avoidance processes during physical stress, with implications for better understanding the nature of panic disorder.     

General self-efficacy,dental anxiety and multiple fears among 20-year-olds in Norway

This paper examines the extent to which low general self-efficacy and painful dental and medical experiences are related to dental anxiety, multiple fears and to avoidance of dental care. A total of 754 20-year-olds completed a series of questionnaires, including the General Self-efficacy Scale (GSE), Geer Fear Scale (GFS) and Dental Fear Survey (DFS). Females had lower self-efficacy, higher dental anxiety and higher scores on the GFS than males. Multivariate analyses (linear stepwise regression) indicated that painful dental experiences, a high score on the GFS and negative opinions about own dental health explained 37% of the variance in DFS scores. Self-efficacy had no predictive power for dental anxiety, and only dental anxiety had predictive power for dental avoidance behavior. Thirty-eight percent of the total variance in GFS scores was explained by the following variables: being a female, high dental anxiety (DFS), low general self-efficacy (GSE) and low educational level of the mother.     

Self-efficacy conception of anxiety

Abstract

In social cognitive theory, perceived self-efficacy to exercise control over potential threats plays a central role in anxiety arousal. Threat is a relational property reflecting the match between perceived coping capabilities and potentially hurtful aspects of the environment. People who believe they can exercise control over potential threats do not engage in apprehensive thinking and are not perturbed by them. But those who believe they cannot manage threatening events that might occur experience high levels of anxiety arousal. Experimental analyses of the microrelation between perceived self-efficacy and anxiety arousal reveal that perceived coping inefficacy is accompanied by high levels of subjective distress, autonomic arousal and catecholamine secretion. Environmental events are not always completely under personal control and most human activities contain some potential risks. The exercise of control over anxiety arousal, therefore, requires not only development of behavioral coping efficacy but also efficacy in controlling dysfunctional apprehensive cognitions. It is not frightful cognitions per se but the perceived self-inefficacy to turn them off that is the major source of anxiety arousal. Analyses of the causal structure of self-protective behavior show that anxiety arousal and avoidant behavior are mainly co-effects of perceived coping inefficacy.     

Emotional Distress Associated with Surgical Treatment and its Relationship with Coping Profiles Among Chronically ill Older Patients

The study determines the patterns of coping styles among older patients with hip osteoarthritis and assesses the derived profiles in terms of perceived stress and anxiety before and after arthroplasty. Sixty-one hospital patients (mean age 70.3 years) were analysed one day before arthroplasty and three months after. The participants were assessed with the Brief-COPE (coping style), PSS-10 (perceived stress) and STAI (anxiety) psychometric tests. Four coping patterns were yielded using data clustering: rational, enterprising (resourceful), potentially maladaptive and flexible. Repeated measures ANOVA indicated a main effect within subjects but did not indicate that decreases of stress and anxiety varied differently between groups. Cluster 1 (a coping profile characterised by high helplessness, low active coping, high avoidance) reported significantly greater stress and anxiety than all other groups before and after hip replacement, while clusters 2 (flexible), 3 (resourceful) and 4 (rational) were characterised by similar levels of anxiety and stress. Older patients with osteoarthritis might differ in terms of emotional response to surgical treatment. Screening for coping styles at admission to hospital may indicate more vulnerable individuals.     

Self-observation versus flooding in the treatment of agoraphobia

The effects on agoraphobia of (1) self-observation with a minimum of therapeutic intervention. (2) flooding, (3) a combination of flooding and self-observation, and (4) no-treatment control were compared. Assessments were made at the beginning of treatment, during and at the end of treatment and at the follow-up three months later. They were carried out by the therapist (in vivo) measurement; phobic anxiety and phobic avoidance scale) by an independent observer (phobic anxiety scale and phobic avoidance scale) and by the client (phobic anxiety scale; phobic avoidance scale: FSS; social anxiety scale; SDS and I-E scale).Self-observation, flooding and flooding/self-observation resulted in significant improvement on several variables, whereas the no-treatment control group did not improve. No difference in effectiveness was found between the self-observation and flooding treatments. In addition, the results suggest that a combined flooding/self-observation treatment is more effective than each of the individual treatments.     

Increased levels of conditioned fear and avoidance behavior coincide with changes in phosphorylation of the protein kinase B (AKT) within the amygdala in a mouse model of extremes in trait anxiety

Patients diagnosed for anxiety disorders often display faster acquisition and slower extinction of learned fear. To gain further insights into the mechanisms underlying these phenomenona, we studied conditioned fear in mice originating form a bi-directional selective breeding approach, which is based on elevated plus-maze behavior and results in CD1-derived high (HAB), normal (NAB), and low (LAB) anxiety-related behavior mice. HAB mice displayed pronounced cued-conditioned fear compared to NAB/CD1 and LAB mice that coincided with increased phosphorylation of the protein kinase B (AKT) in the basolateral amygdala 45 min after conditioning. No similar changes were observed after non-associative immediate shock presentations. Fear extinction of recent but not older fear memories was preserved. However, HAB mice were more prone to relapse of conditioned fear with the passage of time. HAB mice also displayed higher levels of contextual fear compared to NAB and LAB mice and exaggerated avoidance following step-down avoidance training. Interestingly, HAB mice showed lower and LAB mice higher levels of acoustic startle responses compared to NAB controls. The increase in arousal observed in LAB mice coincided with the general absence of conditioned freezing. Taken together, our results suggest that the genetic predisposition to high anxiety-related behavior may increase the risk of forming traumatic memories, phobic-like fear and avoidance behavior following aversive encounters, with a clear bias towards passive coping styles. In contrast, genetic predisposition to low anxiety-related and high risk-taking behavior seems to be associated with an increase in active coping styles. Our data imply changes in AKT phosphorylation as a therapeutic target for the prevention of exaggerated fear memories.     

Influence of response time frame on mood assessment

Abstract

Dental anxiety and the related avoidance of dental treatment can result in severe impairment of health. We investigated the influence on avoidance behavior of phobic severity, gender, characteristics related to generalized anxiety and depression, such as dysfunctional cognitions and sensitivity of bodily symptoms, as well as personality traits of self-efficacy and locus of control. Forty-eight dental phobics were given an initial assessment and avoidance behavior was determined by the degree of observance of three subsequent dental appointments. Principal component analysis revealed separate factors for trait and phobic anxiety as well as for avoidance and dysfunctional cognitions. Women showed a higher degree of avoidance than men. Regression analysis revealed a high desire for control over dental treatment combined with a low level of perceived control as the only significant predictor variable of avoidance. The results suggest that avoidance behavior in dental phobia could be reduced by extending patients’ control over treatment conditions.     

Attachment insecurity as a moderator of cardiovascular arousal effects following dyadic support

We examine the cardiovascular arousal effects of emotional support receipt, and the moderation of these by the support recipient’s and provider’s attachment. Seventy couples engaged in a laboratory dyadic supportive interaction, while their ECG was monitored. With more emotional support, men with high attachment anxiety showed greater arousal reduction during the dyadic interaction, whereas men with low attachment anxiety showed less reduction; additionally, women coupled with partners with high attachment anxiety showed greater arousal reduction, whereas women coupled with partners with low attachment anxiety showed less reduction. Men and women with high attachment avoidance showed less arousal reduction, whereas those with low attachment avoidance showed greater reduction. These results highlight the differential ways in which support gets under the skin.     

The impact of coping and resilience on anxiety among older Australians

Objective: This study aims to explore the relationships between various coping types, resilience, and anxiety among older Australians. Particular attention is paid to whether resilience moderates coping's effect on anxiety. Method: A total of 324 Australians aged between 55 and 90 (M = 66.7, SD = 8.6) were surveyed as part of the study. Moderation was assessed using structural equation modelling and plots of simple slopes. Results: Significant negative correlations were detected between anxiety and both proactive coping and preventive coping. Higher levels of resilience were associated with lower levels of anxiety. Age moderated both proactive coping and reflective coping's effects on anxiety and gender moderated avoidance coping's effect on anxiety. Resilience was found to moderate the relationships between proactive coping and anxiety, and instrumental support seeking and anxiety. For those high in resilience, there was little association between anxiety and proactive coping or anxiety and instrumental support seeking. Among low resilience individuals, there was a negative association between proactive coping and anxiety, but a positive association between instrumental support seeking and anxiety. Conclusion: Resilience, proactive coping, and preventive coping are all important predictors of anxiety among older people. Among those who are low in resilience, proactively coping with stress may be particularly important for good mental health. The results of the study highlight the complexity of the relationship between resilience, coping, and anxiety among older people.     

The discrepant repressor: differentiation between low anxiety, high anxiety, and repression of anxiety by autonomic-facial-verbal patterns of behavior

This study examined the notion that personality questionnaires can be used to predict different styles of coping with anxiety as expressed by individual differences in patterns of autonomic, verbal, and nonverbal reactions. In line with earlier modifications of the repression-sensitization concept, the Taylor Manifest Anxiety Scale (MAS) and the Marlowe-Crowne Social Desirability Scale (SDS) were used to select four groups of 12 subjects each from a pool of 206 male students in Germany: low-anxious subjects (low MAS, low SDS), repressors (low MAS, high SDS), high-anxious subjects (high MAS, low SDS), and defensive high-anxious subjects (high MAS, high SDS). Several measures of autonomic arousal, facial activity, and self-reported affect were obtained during a potentially anxiety-arousing free-association task and during a number of control conditions, including a funny film. Significant differences in baseline-corrected heart rate and self-reported anxiety as well as rated facial anxiety all indicated that repressors exhibited a discrepancy between low self-reported anxiety and high heart rate and facial anxiety; low-anxious subjects reported an intermediate level of anxiety, although they showed low heart rate and facial anxiety; high-anxious subjects had consistently high values on all three variables; and the defensive high-anxious group showed an intermediate level of anxious responding. These group differences were specific to the task of freely associating to phrases of mixed (sexual, aggressive, neutral) content (but not to other experimental situations) and to self-reported anxiety (but not to other self-rated emotions or task difficult), indicating that they reflect individual differences in coping with anxiety.     

Objective and perceived physiological arousal in trait social anxiety and post-event processing of a prepared speaking task

This study investigated the influence of trait social anxiety on subjective and physiological responses to an anticipated stressor. Seventy normotensive female students characterized as either high or low in social anxiety engaged in a demanding speech task after an anticipation period of one week that provided opportunity to prepare for the task. Trait social anxiety substantially influenced objective and perceived physiological arousal. High socially anxious individuals displayed greater heart rate reactivity and greater increases in perceived arousal that were in excess of objective HR reactivity. Perceived, but not objective arousal, partially mediated the relationship between social anxiety and negative post-task reappraisals of perceived coping resources. Furthermore, self-evaluations were found to be an essential determinant of post-task rumination. The results provide support for central predictions of cognitive models on social phobia.     

A Test of Mastery versus Coping Modeling in the Reduction of Children's Dental Fears

This study compared mastery and coping models in the reduction of relatively high fear and tear-related behaviors of children undergoing dental treatment. Boys and girls, ranging form 4-to-12 years of age and reporting high dental fears, were grouped according to previous dental experience (none vs. previous experience). The children were exposed to one of three experimental conditions: a coping model slide-and-audiotape presentation, a mastery model presentation, or a no-slide presentation condition. Subjects' reported levels of dental fear and general anxiety were reassessed following the experimental manipulation. Additionally, subjects' disruptive behaviors were tallied during the subsequent dental treatment. No differences on the dependent measures were found due to exposure to a model, model type, or level of previous dental experience. Combined with other studies, the present results raise critical questions regarding the efficacy of mastery versus coping modeling as well as for the theoretical distinction of the two modeling types.     

The hardy personality: cognitive and physiological responses to evaluative threat

Hardy persons are hypothesized to be resistant to stress-induced illness, because of their adaptive cognitive style and a subsequently reduced level of physiological arousal. We assessed the cognitive and physiological responses of high and low hardy male undergraduates to a challenging task under high and low evaluative threat. As predicted, hardy subjects endorsed more positive self-statements than did low hardy subjects in the high threat condition. High hardy subjects also reported fewer negative self-statements overall, but this was attributable to the overlap of measures of hardiness and neuroticism. Hardy subjects displayed marginally lower arousal while waiting for the task to begin, but this finding did not approach significance when neuroticism was controlled. Hardy subjects also had higher levels of systolic blood pressure, perhaps because of their active coping efforts. Results support the hypothesized hardy cognitive style but raise questions about the type and timing of organismic strain linking hardiness and health.     

Active-imaginal exposure: examination of a new behavioral treatment for cynophobia (dog phobia)

The aims of this study were to investigate exposure-based treatments for cynophobia (dog phobia) and to test a newly developed hybrid imaginal exposure treatment that we have named active imaginal exposure. The treatment introduces an in vivo coping component to imaginal exposure whereby the patient physically performs coping responses to an imagined feared stimulus. Eighty-two participants meeting DSM-IV criteria for specific phobia (animal subtype) were randomly assigned to one of three 30-min. treatments: (a) active-imaginal exposure (AI), (b) imaginal exposure alone (IE), or (c) graduated in vivo exposure (IV). Participants completed a behavioral approach test at pre, post, and four-week follow-up. Significant pre- to posttreatment improvement was observed in all three treatment conditions. Response rates at posttreatment were 51.9, 62.1, and 73.1% for the IE, AI, and IV groups respectively. Likewise, effect sizes at posttreatment were 0.76, 1.41, and 1.55 for the IE, AI, and IV groups respectively. Although in the predicted direction, the between group differences were not significant. A similar pattern of results was observed at follow-up. Further, safety behavior utilization during treatment was associated with less improvement--particularly in the two imaginal treatment conditions. Exposure treatments of dog phobia appear feasible and effective in reducing phobic fear and avoidance associated with dog phobia. Furthermore, preliminary evidence suggests that our active-imaginal exposure treatment may be a viable alternative to in vivo exposure.     

Prediction of psychological reactions to bone density screening for osteoporosis using a cognitive-behavioral model of health anxiety

Pre-screening measures derived from a cognitive-behavioral theory of health anxiety were significant predictors of individual differences in post-screening reactions to a health screening procedure, bone densitometry. Predictors included specific illness beliefs (vulnerability, severity/consequences, coping and treatment) and general health anxiety measures. Three months after a low bone mineral density (BMD) result, women with high levels of pre-existing general health anxiety gave higher ratings of anxiety about osteoporosis and perceived likelihood of developing osteoporosis than women with low levels of preexisting health anxiety, even though the two groups' initial ratings had not differed significantly. Women with a low BMD result generally showed "minimization" of the seriousness of low BMD but women with very high levels of pre-existing health anxiety did not. After a high BMD result, highly health anxious women were only temporarily reassured. The results were consistent with the cognitive-behavioral analysis of health anxiety.     

Changes in immediate memory strategy under induced muscle tension and with time of day

It is suggested that the influence of arousal on immediate memory may, at least in part, be mediated by changes in strategy, such that subjects are less likely to rely on cumulative subvocal rehearsal of the items under high arousal. Experiment I found a detrimental effect of induced muscle tension on immediate memory, but only when subjects were free to engage in such rehearsal, and not under either enforced vocalisation or articulatory suppression. Experiment II manipulated strategy by instruction, and compared immediate memory at 10.30 (low arousal) with that at 19.30 (high arousal). A 10.30 superiority in immediate memory was found when no specific instructions as to how to either encode/store, or recall, the items were given. This superiority disappeared under four of the five alternative types of instruction where subjects were told to group and rehearse the items during presentation, or to recall the items in a specific order, or both. It is concluded that manipulations commonly held to affect arousal level may indeed influence the type of strategy that subjects spontaneously adopt. This may be responsible for some of the inconsistencies in the arousal and memory literature.     

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.