Comorbidity of test anxiety and other anxiety disorders in children

Elementary school children with clinically significant test anxiety, as determined by self-report and a clinical interview, were assessed for the incidence of other fears and anxiety. The results indicated that test-anxious children reported more fears and general worries than their non-test-anxious peers. As expected, the test-anxious children experienced more negative cognitions and subjective distress when taking a test. Furthermore, the fear of negative evaluation was not limited to an actual test, since these children also reported identical symptoms when engaged in a second social-evaluative task. Finally, 60% of the testanxious sample met DSM-III criteria for an anxiety disorder. The results are discussed in terms of the relationship of text anxiety to more complex social-evaluative dysfunctions, more pervasive anxiety conditions, DSM-III anxiety disorders, and the utility of test anxiety as an indicator of the presence of these more pervasive anxiety states.This research is based on a dissertation conducted by the first author under the direction of the second author. Thanks are expressed to Stephen B. Manuck, Scott M. Monroe, Sharon Nelson-LeGall, and Saul Shiffman, who served as committee members. This study was supported in part by National Institute of Mental Health Grants No. 30915 and No. 16804, and a grant to the first author from the Sigma Xi Foundation.     

Precipitation anxiety

Therapy with autistic and psychotic children led the author to introduce the concept of precipitation anxiety. Freud's first theory of the instincts was expressed in the dynamics of conflict, but his subsequent development of life and death instincts is better understood in terms of a gradient of energy between two extremities of the same axis. Object relations result from a caesura (Bion) which creates a gradient of psychic energy experienced initially as a precipice which, if left unregulated, generates intolerable anxiety. Satisfactory emotional encounters with the mind of the object bring about the necessary adjustments to the slope of the gradient. Autistic mechanisms may block off precipitation anxiety, but they also prevent mental growth. Both the dynamics of conflict and the dynamics of the gradient are vital for psychic development, but the very existence of the former is contingent on successful negotiation of the energy gradient (working through). After illustrating his thesis with clinical material drawn from a group therapeutic setting, the author discusses points of convergence and divergence with two other fundamental notions: the aesthetic conflict (Meltzer) and premature psychic birth (Tustin). The proposed model furthers our understanding of the therapeutic process and stresses the importance of the containing object in the transference situation.     

Disclosure of anxiety in everyday life: Effects of social anxiety

The current study examined the likelihood of disclosing one’s anxiety to others during anxiety-provoking conversations, as reported by individuals high or low in social anxiety. It investigated to whom these disclosures are made, and the content and intended purposes of these disclosures. Undergraduate students and community members low (n = 79) or high (n = 81) in social anxiety completed the Anxiety Disclosure in Everyday Life questionnaire, as well as several other measures as part of another study. Analyses indicated that individuals high in social anxiety were significantly less likely to disclose their anxiety as compared to individuals low in social anxiety. The likelihood of disclosing one’s anxiety varied significantly depending on to whom one was speaking, with intimate partners being disclosed to the most. The content of the disclosures typically involved stating that one is feeling shy or nervous without offering an explanation, or attributing it to one’s personality traits (e.g., shyness), with the intended purpose often being to elicit assistance or reassurance from their conversation partner or to manage the impressions of others.     

Health anxiety, hypochondriasis, and the anxiety disorders

Although clinical observations suggest that health-related anxiety is present, to some extent, in a number of anxiety disorders, this relationship has not been examined empirically. The present study therefore utilized the Short Health Anxiety Inventory (SHAI) to elucidate the structure of such symptoms among patients with anxiety disorders and to empirically investigate the presence of health anxiety in various anxiety disorders. Confirmatory factor analysis yielded equivalent support for either a 2-factor or 3-factor model of the SHAI's latent structure. The measure demonstrated good reliability, convergent validity, and discriminant validity. Comparison of SHAI scores across groups of patients with various anxiety disorders revealed elevated levels of health anxiety among patients with hypochondriasis and panic disorder relative to those with other anxiety disorders. Receiver operating characteristic analyses supported the utility of the SHAI as a diagnostic tool for screening patients with hypochondriasis utilizing empirically derived cut scores. Findings are discussed in terms of cognitive-behavioral models of anxiety disorders.     

Anxiety reactivity and anxiety perseveration represent dissociable dimensions of trait anxiety

Trait anxiety is an individual-difference variable reflecting variation in state-anxiety elevations resulting from exposure to a stressor. It is usually measured using questionnaire instruments, such as the Spielberger State-Trait Anxiety Inventory (STAI-T). The present research conceptually distinguishes, and independently assesses, two hypothetical dimensions of anxiety vulnerability which, it is argued, could plausibly make independent contributions to variance in trait-anxiety scores. These dimensions are anxiety reactivity, the probability of experiencing an anxiety reaction to a stressor, and anxiety perseveration, the persistence of anxiety symptoms once elicited. Participants were asked three questions about each STAI-T item. The traditional STAI-T question assessed how much of the time this symptom was experienced; the anxiety-reactivity question assessed the probability of experiencing the symptom in response to a stressor; and the anxiety-perseveration question assessed how long the symptom persisted, if elicited. Regression analysis determined that anxiety reactivity and anxiety perseveration scores both accounted for independent variance in trait-anxiety scores. It is argued that models of anxiety vulnerability should seek to differentiate both the causes and the consequences of elevated anxiety reactivity and increased anxiety perseveration. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Establishing a trait anxiety threshold that signals likelihood of anxiety disorders

Abstract

Evidence suggests that the State Trait Inventory for Cognitive and Somatic Anxiety (STICSA) may be a more pure measure of anxiety than other commonly used scales. Further, the STICSA has excellent psychometric properties in both clinical and nonclinical samples. The present study aimed to extend the utility of the STICSA – Trait version by identifying a cut-off score that could differentiate a group of clinically diagnosed anxiety disorder patients (n=398) from a group of student controls (n =439). Two receiver operating characteristic curve analyses indicated cut-off scores of 43 (sensitivity=.73, specificity=.74, classification accuracy=.74) and 40 (sensitivity=.80, specificity=.67, classification accuracy=.73), respectively. In a large community sample (n =6685), a score of 43 identified 11.5% of individuals as probable cases of clinical anxiety, while a score of 40 identified 17.0% of individuals as probable cases of clinical anxiety. As a result of differences in sensitivity and specificity, the present findings suggest a cut-off score of 43 is optimal to identify probable cases of clinical anxiety, while a cut-off score of 40 is optimal to screen for the possible presence of anxiety 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.     

Trait anxiety moderation of the effects of life stress on state anxiety

Many theories of anxiety have predicted and much previous research has indicated a person × situation interaction between stressors and trait anxiety. This study examined the hypothesized role of individual differences in trait anxiety in the relationship between naturally occurring stressors and state anxiety scores. Two hundred eighty-seven college undergraduates completed the State-Trait Anxiety Inventory, which provides both state and trait anxiety measures, and the Life Experiences Survey, which provides a measure of the amount of stress a person has undergone in the previous year. Trait anxiety scores were divided into quartiles and correlations between state anxiety scores and Life Experiences Survey scores and multiple regressions for trait anxiety and life stress to predict state anxiety were computed within each quartile. The results were that only in the first quartile was there a significant correlation between life stress and state anxiety, which was contrary to the predictions of state-trait anxiety theory. The validity of state-trait anxiety theory, as it relates to life stress, was questioned.