Reliability and validity of some specific fear questionnaires

Normative psychometric data on a Swedish translation of fear questionnaires concerning snakes, spiders, public speaking, and mutilation given to 223 college students are presented. High internal consistencies were found for all four questionnaires, and low intercorrelations among the four inventories emerged. In a separate study the inventories were administered to a clinical sample of spider and snake phobics. Phobics scored higher on their respective phobic scale than the college group but did not differ from controls on mutilation or public speaking scales. A significant negative correlation emerged between snake and spider scores among the phobics. One year test-retest reliabilities in the phobic sample were high. Finally, snake and spider phobics viewed and rated phobic and nonphobic slides. Snake phobics rated snake slides as more aversive than spider slides, whereas the reverse was true for spider phobics. The correlation between fear ratings and questionnaire scores was significant. Use of these scales in evaluating therapeutic changes is encouraged.     

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.     

Avoidant personality disorder and the generalized subtype of social phobia.

Social phobia and avoidant personality disorder (APD) may be given as comorbid diagnoses. However, it is not known if the labels provide independent, useful diagnostic information. We classified social phobics by social phobia subtype and presence of APD. Generalized social phobics with and without APD (ns = 10 and 10) and nongeneralized social phobics without APD (n = 10) were distinguished on measures of phobic severity. The generalized groups also showed earlier age at onset and higher scores on measures of depression, fear of negative evaluation, and social anxiety and avoidance than did the nongeneralized group. APD criteria of general timidity and risk aversion were more frequently endorsed by social phobics with APD. The data suggest that both the generalized subtype of social phobia and the presence of APD do provide useful diagnostic information but the additional diagnosis of APD may simply identify a severe subgroup of social phobics.     

Is agoraphobia harder to treat? A comparison of agoraphobics' and simple phobics' response to treatment

Agoraphobia is reputed to be more difficult to treat than simple phobia. In a test of this supposition, 38 agoraphobics and 19 simple phobics were each given 10 sessions of graduated in vivo exposure. They were assessed before and after therapy using a behavioral avoidance test, behavioral diaries, and self-report measures. Analysis of covariance revealed unequivocal posttest differences only on self-assessed disability level; agoraphobics had changed less in their report of global disability immediately following treatment but not at follow-up. Sixty-eight percent of the simple phobics showed clinically significant improvement on avoidance of the Main Phobia, compared with 34% of the agoraphobics. On three other outcome measures, including more precise behavioral measures of phobia, agoraphobics and simple phobics responded equivalently to treatment. Given clinicians' impression about the comparative difficulty in treating agoraphobic clients, fewer differences in treatment response were obtained than were expected. Several possible explanations for this discrepancy are discussed.     

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

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

Self-reported automaticity and irrationality in spider phobia

Spider phobic women (n = 39) and nonfearful controls (n = 41) completed a 20-item questionnaire measuring the extent to which they experience their fear reactions to spiders as automatic and irrational. For the phobic sample, therapy outcome data were also collected. Results suggest that spider phobics tend to view their attitude to spiders as irrational and in this respect, they do not differ from control subjects. Furthermore, compared to control subjects, phobics more often perceive their responses to spiders as automatic, i.e., not under intentional control. Contrary to expectation, no robust correlation was found between automaticity and irrationality. Interestingly, automaticity was not related to treatment outcome, while irrationality to some extent predicted therapy outcome (i.e., the more phobics experienced their fear as irrational, the more they profited from exposure treatment).     

Discrepancy between self- and observer ratings of performance in social phobics.

Twenty-eight subjects meeting Diagnostic and Statistical Manual of Mental Disorders (rev. 3rd ed.; American Psychiatric Association, 1987) criteria for social phobia and without a comorbid affective disorder and 33 nonclinical controls were asked to present a brief, impromptu speech to a small audience. Speakers themselves, as well as members of the audience, rated each speaker on a public speaking questionnaire that included both specific items (e.g., voice shook) and global items (e.g., appeared confident). For global items, no significant difference was indicated between the two groups on observers' ratings of public speaking performance. However, social phobics rated their own performance worse than did nonclinical controls, and there was a significantly greater discrepancy between self and other ratings for social phobics than controls. Fear of negative evaluation was the only significant predictor of the self-other discrepancy on global items.     

Stroop interference, self-focus and perfectionism in social phobics

Stroop interference was studied in a group of social phobics under two conditions: presence or absence of a mirror. The mirror was used with the purpose of inducing a higher level of self-focus during testing; this was expected to activate dysfunctional self structures that would increase Stroop interference on socially threatening words. The social phobics showed a Stroop interference effect on socially threatening words, but not on physically threatening words or colour words, relative to the control group. The hypothesis that the presence of the mirror would increase the Stroop interference on socially threatening words, however, was not supported by the data. On the other hand, the social phobics scored significantly higher than the controls on trait measures of self-consciousness and perfectionism. There was a correlation between perfectionism (concern over mistakes) and Stroop interference on socially threatening words. Self-consciousness also correlated with Stroop interference, but this effect was unexpectedly seen most clearly on physically threatening words.     

Questionnaire dimensions of spider phobia: a replication and extension

Two studies are presented in this paper. The first presents an analysis of an extended version of the Spider Phobia Questionnaire (SPQ), which can be used to assess cognitive, behavioural and physiological aspects of responsiveness to spiders in spider phobics. The second examines the relationship between these measures and measures of behavioural avoidance, subjective anxiety and physiological response in high and low fear subjects during an avoidance test. The lack of an expected relationship between the two sets of measures is discussed.     

Stability of Cognitive Bias for Threat Cues in Phobia

The present study examined whether the cognitive bias for threat is a stable phenomenon in spider phobics and not in nonphobic controls. The rationale of this study was that the use of emotional bias for individual assessment in clinical practice requires stability of this phenomenon. In order to assess the stability of the emotional bias, the spider Stroop task was administered twice to spider phobics and controls, with a time lag of 3 weeks. In two experiments, spider phobics (n_{exp. 1} = 20; n_{exp. 2} = 33) and controls (n_{exp. 1} = 24; n_{exp. 2} = 25) were selected on basis of a structured interview. In the second experiment, subjects anticipated exposure to a real-life spider. Emotional bias was inferred from color-naming latencies on spider words versus control words. In line with our prediction, the bias for threat was stable in spider phobic individuals but not in controls. This stability could not be attributed to a general cognitive characteristic because a standard Stroop task did not differentiate between the spider phobics and the controls. The results support the view that cognitive processing of threat in anxiety is stable. It is proposed to use both the emotional bias and its stability as measures of the constraints on the flexibility of the cognitive fear-network.     

UCS expectancy biases in spider phobics: underestimation of aversive consequences following fear-irrelevant stimuli

This paper reports the results of two studies investigating judgements made by spider phobics about the potential threatening consequences (unconditioned stimulus, UCS, expectancies) associated with their phobic stimulus, fear-relevant (FR) stimuli, and fear-irrelevant (FI) stimuli. Using a 'thought experiment' UCS expectancy paradigm, the studies reported found that (1) spider phobics reported significantly higher UCS expectancies to spider stimuli than nonphobics, (2) spider phobics consistently underestimated the probability of aversive consequences following FI stimuli and (3) this underestimation of UCS expectancies to FI stimuli in phobics was not the result of a contrast effect resulting from sequential FR and FI judgements. This differential effect may have important implications for the kind of mechanism which mediates judgements about phobic consequences. These findings suggest that the dimensions on which phobic stimuli are categorised may be 'stretched' in the case of phobics and that this gives rise to the comparative underestimation of threat associated with FI stimuli but also makes phobics more vulnerable to acquiring other phobias.     

Acquisition of blood and injection phobia and anxiety response patterns in clinical patients.

The ways in which blood phobics (N = 81) and injection phobics (N = 56) had acquired their phobias were retrospectively investigated. The patients were required to answer a questionnaire concerning: (a) the origin of the phobia, with items relevant for conditioning experiences, vicarious experiences and experiences of negative information/instruction; (b) physiological reactions; (c) anticipatory anxiety; and (d) negative thoughts while in the phobic situation. In addition background data on marital and occupational status, family history of phobia, fainting history, and severity of the phobia were obtained. Furthermore, the patients' behavioral, physiological, and cognitive-subjective reactions during the behavioral test were assessed. The results showed that a majority (52%) of the patients attributed the onset of their phobias to conditioning experiences, while 24% recalled vicarious experiences, 7% instruction/information and 17% could not remember any specific onset circumstances. There was no significant relationship between ways of acquisition and anxiety components, nor did conditioning and indirectly acquired phobias differ in severity.     

Psychophysiological and subjective reactions of social phobics and normals to facial stimuli

Nine social phobics and 9 normal control subjects were exposed to slides of angry faces, happy faces, and neutral objects (i.e. flowers or mushrooms). Skin conductance responses (SCRs) to the stimuli and eyeblink rate (EBR) during stimulus exposure were recorded. In addition, subjects were asked to rate the stimuli in terms of pleasantness. While angry face stimuli elicited greater SCRs, stronger inhibition of EBR, and were evaluated more negatively than the other stimuli, there were no differences between social phobics and normals in these respects. Thus, the findings lend no support to the idea that social phobics are particularly sensitive to facial cues in general or to negative facial cues in particular.     

Preattentive bias for snake words in snake phobia?

Stroop interference and skin conductance responses (SCRs) for words related to snakes, spiders, flowers, and mushrooms were studied in a group of women (n=40) with snake phobia who were randomised to a stress or no-stress condition. The 21 low-stress snake phobics showed Stroop interference for unmasked (but not for masked) snake words, compared with 21 age- and sex-matched controls. Stroop interference was not significantly different between high-stress and low-stress snake phobics. No support for stronger SCRs for masked snake words was found in snake phobics in a lexical decision task with masked presentations of the same words. The lack of a masked Stroop interference in snake phobics suggests a possible difference in cognitive-emotional mechanisms underlying specific phobia vs. other anxiety disorders that deserves further investigation.     

Public and private heart rate feedback in social phobia: a manipulation of anxiety visibility

According to cognitive behavioural models of social phobia, bodily symptoms are the main source of information concerning social evaluation for social phobics. Experience and perception of bodily symptoms therefore play an important role in social anxiety. In this study we evaluated the effects of anxiety visibility on patients and controls using feedback of veridical heart sounds. A total of 32 social phobics and 32 controls were asked twice to sit in a chair and appear relaxed while being evaluated. Half of the participants heard their heart sounds first via headphones and then via loudspeakers which were also audible to observers. The presentation order of the heart sound was reversed for the other half of the subjects. Social phobics reported substantially more anxiety than controls. Both groups showed habituation in heart rate from the first to the second presentation, and both groups reported perception of a higher heart rate, but only social phobics reported significantly more anxiety and were more worried about their heart rates in the public than in the private condition. These effects were in excess of actual heart rate differences. In conclusion, social phobics worried about the broadcast of a bodily anxiety symptom, whereas controls did not. Information about arousal made public has a strong potential to increase anxiety levels in social phobics.     

Public and private heart rate feedback in social phobia: a manipulation of anxiety visibility

According to cognitive behavioural models of social phobia, bodily symptoms are the main source of information concerning social evaluation for social phobics. Experience and perception of bodily symptoms therefore play an important role in social anxiety. In this study we evaluated the effects of anxiety visibility on patients and controls using feedback of veridical heart sounds. A total of 32 social phobics and 32 controls were asked twice to sit in a chair and appear relaxed while being evaluated. Half of the participants heard their heart sounds first via headphones and then via loudspeakers which were also audible to observers. The presentation order of the heart sound was reversed for the other half of the subjects. Social phobics reported substantially more anxiety than controls. Both groups showed habituation in heart rate from the first to the second presentation, and both groups reported perception of a higher heart rate, but only social phobics reported significantly more anxiety and were more worried about their heart rates in the public than in the private condition. These effects were in excess of actual heart rate differences. In conclusion, social phobics worried about the broadcast of a bodily anxiety symptom, whereas controls did not. Information about arousal made public has a strong potential to increase anxiety levels in social phobics.     

Covariation bias,classical conditioning,and phobic fear

The present study investigated whether phobics show an illusory correlation (IC) between phobia-relevant stimuli and aversive events. Nineteen treated and 19 untreated spider phobics were exposed to a series of 72 slides. Three different categories were used: Phobia-relevant slides (spiders), alternative fear-relevant slides (weapons), and neutral slides (flowers). Slides were randomly paired with either a shock, a siren, or nothing at all. All slide/outcome combinations occurred equally frequently. A posteriori recorded contingency estimates indicated that untreated phobics dramatically overestimate the covariation of spiders and shock. On-line recorded outcome expectancies revealed that the bias to overestimate the spider-shock contingency is highly resistant to extinction. The covariation bias was accompanied by differentially heightened electrodermal first interval responses (FIR) and unconditioned electrodermal responses (third interval responses: TIR) on phobia-relevant trials. Treated phobics did not show a covariation bias, indicating that such bias can be modulated by behavioral treatment. The present findings sustain the hypothesis that phobic subjects process information in a fear-confirming way.     

Ways of acquiring phobias and outcome of behavioral treatments

The way of acquisition of phobias was studied in relation to different behavioral treatments for phobias. Ss (N = 183) were clinical patients belonging to six different phobic groups (agoraphobics, claustrophobics, social phobics, animal phobics, blood phobics and dental phobics), and the treatments were categorized as behaviorally focused (exposure in vivo and social-skills training), physiologically focused (systematic desensitization and applied relaxation) and cognitively focused (self-instruction training and fading). Results showed that both for patients with direct conditioning experiences and indirect acquisition those treated with behavioral and physiological methods improved more than those receiving cognitive methods when looking at the change-score data. Regarding the proportion of clinically improved patients there was no difference between treatments among the Ss with a background of conditioning experiences. In the group with indirect acquisition, on the other hand, the cognitive methods were more effective.     

Validity of Two Questionnaires to Assess Social Fears: The Dutch Social Phobia and Anxiety Inventory and the Blushing, Trembling and Sweating Questionnaire

This report evaluates some psychometric properties of the Dutch Social Phobia and Anxiety Inventory (SPAI-N) as well as a newly developed instrument to assess fear of showing somatic symptoms among social phobic, the Blushing, Trembling and Sweating Questionnaire (BTS-Q). Results support the reliability and discriminative validity of the Dutch SPAI and the BTS-Q. Both questionnaires are able to discriminate social phobics from a community sample. Social phobics with fear of blushing, trembling, and sweating as the main complaint could be discriminated from social phobics without fear of blushing, trembling, and sweating as the main complaint using the BTS-Q. In contrast with expectations derived from cognitive models of social phobia, social phobics with fear of blushing, trembling, and sweating did not have stronger dysfunctional beliefs about (the social consequences of) blushing, trembling, and sweating than social phobics without such fears.     

Covariation detection in treated and untreated spider phobics.

Twenty treated and 18 untreated spider phobics were exposed to a series of 72 slides. Three different categories of slides were used: phobia-relevant slides (spiders), alternative fear-relevant slides (weapons), and neutral slides (flowers). Slides were randomly paired with either a shock, a tone, or nothing at all. Despite the absence of a systematic correlation between slides and outcomes, untreated phobics strongly overestimated the covariation between spider slides and shock. Treated phobics did not show a covariation bias, suggesting that such bias can be modulated by behavioral treatment. In addition, untreated subjects were more confident about their contingency estimates than were treated subjects. The present results fit with earlier studies.