Patterns of Response and Remission Following a One-Session Treatment for Blood-Injection-Injury Phobia in Youth

Blood-Injection-Injury (BII) Phobia is a severe and impairing disorder that has been understudied in youth. The present study aimed to define patterns of response and remission following a modified One-Session Treatment (OST) including an e-therapy maintenance program for children and adolescents with BII Phobia. Moreover, characteristics of different responder groups were examined in order to determine correlates of a poorer response. Youth (n?=?20; 8–18 years) were categorized into four responder groups (e.g., immediate remitter, delayed remitter, partial responder, and nonresponder) based upon defined criteria for remission. Immediate remitters to treatment were more likely to have a primary diagnosis of injection phobia, rather than a combined blood and injection phobia. Nonresponders reported significantly greater disgust sensitivity at pretreatment and were more likely to have a comorbid diagnosis of Social Phobia. In regards to within session change, youth who achieved the exposure goal of having a blood test during treatment had a significantly stronger treatment response. These preliminary findings may assist clinicians in the planning and delivering of intensive Cognitive Behavioral Treatment (CBT) approaches for BII Phobia in youth.     

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 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.     

Specific Phobia in Youth: Phenomenology and Psychological Characteristics

Sociodemographic and psychological characteristics of 62 youth with animal and natural environment types of specific phobia were examined in a treatment-seeking sample. Differences due to age, sex, ethnicity, family structure, and family socioeconomic status were not found between youth with the two types of specific phobia. Moreover, differences were not obtained between the two groups in the clinical severity of their phobias, the perceived dangerousness of the feared outcomes associated with their phobias, the perceived levels of coping with their phobias, or overall fearfulness. However, differences between youth with the two types of specific phobias were found on somatic/anxious symptoms, depressive symptoms, and life satisfaction. In addition, differences were noted on withdrawn, somatic complaints, anxious/depressed symptoms, and social problems as reported by the mothers of these youngsters. Finally, differences in the percent of co-occurring anxiety disorders between youth with the two types of specific phobia were found. On all of the domains in which differences were found, youth with the natural environment type fared more poorly than those with the animal type. These findings converge with those obtained in treatment studies which indicate that youth with the natural environment type are more difficult to treat than youth with the animal type.     

Dysfunctional Cognitions in Children with Social Phobia, Separation Anxiety Disorder, and Generalized Anxiety Disorder

According to cognitive theories of anxiety, anxious adults interpret ambiguous situations in a negative way: They overestimate danger and underestimate their abilities to cope with danger. The present study investigated whether children with social phobia, separation anxiety disorder, and generalized anxiety disorder have such a bias, compared to a clinical and a normal control group. Children were exposed to stories in which ambiguous situations were described, and asked to give their interpretations, using open and closed responses. Results showed that anxious children reported more negative cognitions than control children. However, anxious children did not overestimate danger on the free responses, but they did judge the situations as more dangerous on the closed responses. Anxious children had lower estimations of their own competency to cope with danger than the control groups on both open and closed responses. The results indicate that children with anxiety disorders have dysfunctional cognitions about ambiguous situations.     

Cross-Informant Agreement in the Assessment of Social Phobia in Youth

In the present study involving children and adolescents with a principal diagnosis of social phobia, we measured parent–child agreement regarding social anxiety symptoms. Additionally, we examined variables related to the severity of the children's social phobia symptoms as reported by children and as rated by clinicians. Examination of cross-informant agreement indicated little difference between mean parent and children ratings of the children's social fears. In contrast, there was a significant difference in parent and children ratings of the children's avoidance, with parents endorsing greater degrees of social avoidance. Children's report of social avoidance was negatively related to scores on a measure of self-presentational concerns (i.e., social desirability). Clinicians' determination of the severity of the children's social phobia was also influenced by the children's self-presentation as well as parent report of social avoidance and children's depression scores. Thus, this differential weighting by the clinician of parent versus child report may be related to the finding that children's self-reported social avoidance was negatively related to their concerns regarding positive self-presentation. Results suggest the need to consider the impact of social desirability when examining clinical characteristics of children and adolescents with social phobia.     

Cognitive Correlates of Social Phobia Among Children and Adolescents

We examined different cognitive phenomena in relation to social phobia among children (aged 7 to 11) and adolescents (aged 12–16) separately. Fifty socially phobic youths were compared to 30 normal control children on measures of social anxiety, social expectation as well as self- and observer-rated performance during two social tasks involving a same-aged peer. Additionally, a video-mediated recall procedure was conducted immediately following the two behavioral tasks to examine specific types of self-talk. Results indicated that socially phobic youths had lower expectations of their performance and rated their actual performance worse than controls during a social interaction task, but not a read-aloud task. Self-ratings of decreased performance among socially phobic youths were corroborated by blind observers. Although differences in specific types of self-talk were found between the two groups, these findings were generally moderated by age. Furthermore, certain cognitive symptoms associated with the disorder were more commonly found among older socially phobic youths. The current findings highlight the importance of considering developmental factors in the presentation and treatment of social phobia in youths.     

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.     

Internet-Delivered CBT for Children with Specific Phobia: A Pilot Study

Background: Cognitive behavior therapy (CBT) has been shown to be an effective treatment for specific phobia in youth, but not all affected seek or receive treatment. Internet-delivered CBT could be a way to increase the availability of empirically supported treatments. Aims: An open trial was conducted to evaluate Internet-delivered CBT for children with specific phobia. Method: Children (N = 30) aged 8–12, and their parents, with a principal diagnosis of specific phobia were recruited through media advertisement. Participants received six weeks of Internet-delivered CBT with therapist support. The treatment was aimed for the parents and the children, with the first part being only for the parents. The primary outcome measure was the Clinician Severity Rating (CSR), and secondary measures included clinician-rated global functioning and child- and parent-reported anxiety and quality of life. All assessments were made at pretreatment, posttreatment, and three-month follow-up. Results: At posttreatment, there were significant reductions on the CSR, with a large within-group effect size (Cohen's d = 1.0) and 35% of children no longer meeting criteria for specific phobia. Self-report measures from parents and children showed significant effects on anxiety, with small to moderate effect sizes. Effects were maintained at three-month follow-up. Conclusions: Results show that Internet-delivered CBT with therapist support for children with specific phobia has the potential to reduce symptom severity. Randomized controlled trials are needed to further evaluate this treatment format.     

Effects of experienced disgust on habituation during repeated exposure to threat-relevant stimuli in blood-injection-injury phobia

Despite growing evidence implicating disgust in the etiology of blood-injection-injury (BII) phobia, the relevance of disgust for exposure-based treatment of BII phobia remains largely unknown. Individuals with BII phobia were randomly assigned to a disgust (view vomit videos) or neutral activation (view waterfall videos) condition. They were then exposed to 14 videotaped blood draws, during which fear and disgust levels were repeatedly assessed. Participants then engaged in a behavioral avoidance test (BAT) consisting of exposure to threat-relevant stimuli. Examination of outcome comparing the identical first and last blood-draw clips revealed that fear and disgust toward blood draws was significantly reduced in both groups. Disgust levels were also found to be more intense for the video stimuli relative to fear levels whereas the opposite was true for BAT stimuli. Contrary to predictions, the disgust induction did not enhance reductions in negative responses to the target video or reduce behavioral avoidance. Growth curve analyses did show that individuals with BII phobia exposed to the disgust induction showed greater initial fear levels during repeated exposure than those in the neutral condition. However, this effect was not consistently observed across different analytic approaches. Changes in fear during exposure were also found to be independent of changes in disgust but not vice versa, and greater initial fear levels during repeated exposure to threat was associated with fear and disgust levels during the BAT. The implications of these findings for conceptualizing the role of disgust in etiology and treatment of BII phobia are discussed.     

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.     

Social phobia in youth: the diagnostic utility of feared social situations

The present study evaluated the utility of parent- and child-reported social fears for reaching a diagnosis of social phobia in youth. The diagnostic utility of (a) the number of fears and (b) specific feared social situations was examined. The sample included 140 youth and their parents: youth diagnosed with social phobia (n=50), youth diagnosed with generalized anxiety disorder or separation anxiety disorder but not social phobia (n=49), and youth without an anxiety disorder (n=41). Youth and their parents were interviewed separately using the Anxiety Disorders Interview Schedule for Children and Parents. Analyses indicate that a cut score of 4 parent-endorsed social fears optimally distinguished youth with and without social phobia. Analyses of child-reported fears did not identify a meaningful cut score. Conditional probability and odds ratio analyses indicated that several specific social fears have high diagnostic efficiency, and others were found to have limited diagnostic efficiency. Results are discussed with regard to informing diagnostic interviews and diagnostic systems for social phobia in youth.     

Characteristics of Blood-Injection-Injury Fears in People Receiving Intravenous Chemotherapy

Blood-Injection-Injury (BII) phobia is associated with distress and avoidance in response to blood, injury, or receiving injections. BII phobia can therefore create problems for those receiving medical procedures such as chemotherapy. The prevalence rate of BII in the general population has been estimated to be less than 5% but as many as 19% of outpatients receiving chemotherapy surveyed by Carey and Harris (Behaviour Change 22:5–90, 2005) reported BII concerns. This study examined the extent and characteristics of BII concerns among outpatients receiving chemotherapy for the first time (n = 124). Almost 17% of the sample had scores on the Mutilation Questionnaire comparable to samples with clinical BII phobia. Those assigned to a high BII concern group based on Mutilation Questionnaire scores reported higher somatic and fainting responses to BII stimuli and elevated disgust sensitivity, compared to groups selected for low BII concerns. Females had significantly higher Mutilation Questionnaire scores than males. Thus, the BII concerns of outpatients receiving chemotherapy appear qualitatively similar to the concerns reported by clinical BII phobia samples and analogue student samples. We suggest that the standard inclusion of a brief, reliable screening measure of BII concerns for outpatients scheduled for chemotherapy, coupled with brief, effective interventions to reduce BII-related distress, may be warranted.     

The Relevance of Age of Onset to the Psychopathology of Social Phobia

The present study aimed to examine the relevance of age of onset to the psychopathology of social phobia using a large clinical sample of 210 patients with social phobia. The two most common periods of onset were during adolescence (ages 14–17) and early childhood (prior to age 10). Structural regression modeling was used to test predictions that early onset social phobia would be associated with greater severity of the disorder, stronger current symptoms of depression and anxiety, greater functional impairment, and more pronounced levels of emotional disorder vulnerabilities (e.g., neuroticism/behavioral inhibition, extraversion, perceptions of control). Logistic regression was used to evaluate relationships between age of onset and the presence of acute and chronic stress at the time of onset. Results showed that earlier age of social phobia onset was associated with stronger current psychopathology, functional impairment, and emotional disorder vulnerabilities, and that later age of onset predicted the presence of an acutely stressful event around the time of disorder emergence. These results are discussed in regard to their clinical implications and congruence with prominent etiological models of the emotional disorders.     

Association between bullying victimization and physical fitness among children and adolescents

Background/ObjectiveThe aim of the study was to analyze the relationship between being bullied and the physical fitness components, and to determine whether a healthy physical fitness level is related with lower victimization in children and adolescents with overweight and obesity compared to unfit overweight/obese peers. Method:The present cross-sectional study included a total of 7,714 youths (9-17 years), categorized as normal-weight or overweight/obese and fit or unfit according to sex-specific handgrip strength and cardiorespiratory fitness (CRF) cut-points. Bullying (physical, verbal, social exclusion, sexual harassment, and cyberbullying) was assessed through the Standard Health Behavior in School-aged Children survey questions. Results:Boys and girls that were categorized as fit (healthy level of CRF) showed lower traditional bullying compared to unfit counterparts. Also, a healthy level of CRF could be a protective factor of traditional bullying among overweight/obese youths compared to unfit overweight/obese peers. Conclusions:CRF is related with lower risk for experiencing traditional bullying in Latino youths with and without obesity, thus emphasizing the role of fitness even among youth with excess of adiposity.     

Presence,Content, and Characteristics of Memories of Individuals with Dental Phobia

Knowledge about memories of distressing events underlying fears and specific phobias is limited. This study assessed (1) the presence, content, and characteristics of memories of events that initiated or exacerbated dental anxiety levels; and (2) the relationship between dental trait anxiety and some key features of these memories. This study used a semi‐structured interview and included dental phobics (n = 42), subthreshold dental phobics (n = 41), and normal controls (n = 70). Dental phobics were more likely to report a memory underlying their anxiety than the normal controls. Moreover, dental phobics' memories were reported as more vivid, disturbing, and more intensely relived than the memories of the normal controls. Greater severity of dental trait anxiety was significantly associated with greater disturbance of patients' memories. The results suggest that memories of distressing events play a significant role in the development of dental phobia and that their characteristics are associated with severity of dental trait anxiety. Copyright © 2015 John Wiley & Sons, Ltd.     

Relations Among Symptoms of Social Phobia Subtypes, Avoidant Personality Disorder, Panic, and Depression

This study's primary goal was to examine relations between symptoms of specific social phobia (SSP), generalized social phobia (GSP), avoidant personality disorder (APD), and panic and depression. Past research has suggested a single social phobia continuum in which SSP displays less symptom severity than GSP or APD. We found SSP symptoms correlated less strongly with depression but more strongly with panic relative to both GSP and APD symptoms. These findings challenge a unidimensional model of social phobia, suggesting a multidimensional model may be more appropriate. These findings also inform current research aimed at classifying mood and anxiety disorders more broadly by identifying that the different factors of fear versus distress appear to underlie different subtypes of social phobia.     

Emotional responding to fearful and disgusting stimuli in specific phobics

Individuals with small animal and blood-injection-injury (BII) phobias respond to phobia-relevant stimuli with both fear and disgust. However, recent studies suggest that fear is the dominant emotional response in animal phobics whereas disgust is the primary emotional response in BII phobics. The present study examined emotional responding toward pictures of spiders, surgical procedures, and two categories of general disgust elicitors (rotting food and body products) among analogue spider phobics, BII phobics, and nonphobics. Dominant emotional responses to phobia-relevant stimuli clearly differentiated the groups. as spider phobics were more likely to be classified as primarily fearful when rating pictures of spiders (74%), whereas BII phobics were more likely to be classified as primarily disgusted when rating pictures of surgical procedures (78%). Discriminant function analyses revealed that disgust ratings, but not fear ratings, of the phobic pictures were significant predictors of phobic group membership. Both phobic groups were characterized by elevated disgust sensitivity toward video and pictorial general disgust elicitors. Implications and suggestions for continued research examining fearful and disgusting stimuli in specific phobia are outlined.     

A Cross-Cultural Comparison of Social Phobia Symptoms

This study examined two forms of social anxiety or phobia, social phobia as defined by DSM-IV and Taijin Kyofusho (TKS, a Japanese form of social anxiety), in relation to their respective culturally prescribed self-construals as independent and interdependent. Japanese university students (N = 124) and U.S. university students (N = 123) were administered the Social Interaction Anxiety Scale, the Social Phobia Scale, the TKS Scale, and the Self-Construal Scale. From the results of a hierarchical regression analysis, TKS symptoms are more likely to be expressed by individuals who are Japanese and individuals who construe themselves low on independence but high on interdependence. In addition, social phobia symptoms are more likely to be expressed by individuals who construe themselves low on independence but high on interdependence irrespective of culture. Implications for therapists from each culture who have clients who present social anxiety or phobia symptoms are discussed.     

Contamination vs. harm-relevant outcome expectancies and covariation bias in spider phobia

There is increasing evidence that spiders are not feared because of harmful outcome expectancies but because of disgust and contamination-relevant outcome expectancies. This study investigated the relative strength of contamination- and harm-relevant UCS expectancies and covariation bias in spider phobia. High (n=25) and low (n=24) spider fearful individuals saw a series of slides comprising spiders, pitbulls, maggots, and rabbits. Slides were randomly paired with either a harm-relevant outcome (electrical shock), a contamination-related outcome (drinking of a distasting fluid), or nothing. Spider fearful individuals displayed a contamination-relevant UCS expectancy bias associated with spiders, whereas controls displayed a harm-relevant expectancy bias. There was no evidence for a (differential) postexperimental covariation bias; thus the biased expectancies were not robust against refutation. The present findings add to the evidence that contamination ideation is critically involved in spider phobia.