Attachment, Behavioral Inhibition, and Anxiety Disorders Symptoms in Normal Adolescents

The current study examined relationships between attachment style, behavioral inhibition, and anxiety disorders symptoms not only relying on youths' self-report but also including the parents' point of view. A large group of young adolescents aged 11–15 years and their parents (N = 280) completed measures of attachment style and behavioral inhibition and the Revised Children's Anxiety and Depression Scale, a questionnaire designed to measure symptoms of anxiety disorders in terms of the Diagnostic and Statistical Manual of Mental Disorders. Highly similar results were found for child and parent report. That is, attachment style and behavioral inhibition were found to be interrelated with insecure attachment being associated with higher levels of behavioral inhibition. Furthermore, adolescents who were classified as insecurely attached and/or high on behavioral inhibition displayed higher levels of anxiety disorders symptoms. Finally, attachment status and behavioral inhibition both accounted for a unique proportion of the variance of anxiety disorders symptomatology.     

Psychopathology in anxiety disorders

Complaints of anxiety, often meetingDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III), criteria for anxiety disorder, are among the most common problems presenting to health practitioners. In spite of the frequency of anxiety and anxiety disorders, little is known about the basic psychopathology of these conditions that would lead to the development of more efficient and effective treatments and possible preventive efforts. Recently, there has been an increase in research on the psychopathology of anxiety disorders from biological, psychological, and social perspectives. The National Institute of Mental Health's Clinical Research Branch sponsored a 2-day workshop of investigators representing diverse research approaches to discuss emerging issues and research practices within the anxiety disorders. Discussions centered on a review of the general areas of classification, phenomenology, and etiology. A selective summary of this workshop is presented along with recommendations for specific research directions.     

Issues in diagnosing anxiety disorders

Research progress in the anxiety disorders is predicated on a useful classification system. In this paper, we review the reliability and validity data for theDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III) anxiety disorders and discuss the salient issues associated with both the conceptualization of anxiety disorders and the diagnostic criteria offered in the DSM-III. It is concluded that the diagnostic reliability for these disorders is, overall, satisfactory. A dearth of validity data, however, hinders progress in both the diagnosis and the treatment of the anxiety disorders. Nevertheless, the DSM-III work group has proposed several changes in the diagnostic criteria for the anxiety disorders. We find some of these proposed changes helpful in that they clarify current diagnostic criteria; changes in diagnostic criteria that alter the basic classification schema, however, seem to be premature.Preparation of this paper was supported in part by MIMH Research Grant 1368.On sabbatical leave from Indiana State University.     

Comparisons of children with delayed and normal language at 24 months of age on measures of behavioral difficulties,social and cognitive development

This investigation compared a group of expressive language-delayed children with language-normal children of the same age (M = 25.7 months; SD = 0.8 months) on various measures of development and behavioral difficulties. Data were obtained through language sampling, direct developmental assessment, and maternal reports of children's development and behavior. Scores on measures of social and cognitive development for children with language delay were found to be significantly lower than normals. Further, maternal reports indicated that these children displayed significantly more behavioral difficulties overall than did the language-normal children. Specifically, the language-delayed children exhibited more symptoms of anxiety and depression, withdrawal, sleep problems, and other behavioral disturbances. In addition, children evaluated as expressive language delayed scored significantly lower on measures of receptive language, maternal ratings of communicative competency, and other indices of language proficiency. The results point to the centrality of expressive and receptive language development in relation to early-appearing behavior problems and other developmental milestones. With these findings in mind, early language intervention may not only promote language development, but also prevent the development or exacerbation of socioemotional problems. © 1998 Michigan Association for Infant Mental Health     

Mood,Anxiety, and Substance‐Use Disorders and Suicide Risk in a Military Population Cohort

There are meager prospective data from nonclinical samples on the link between anxiety disorders and suicide or the extent to which the association varies over time. We examined these issues in a cohort of 309,861 U.S. Air Force service members, with 227 suicides over follow‐up. Mental disorder diagnoses including anxiety, mood, and substance‐use disorders (SUD) were based on treatment encounters. Risk for suicide associated with anxiety disorders were lower compared with mood disorders and similar to SUD. Moreover, the associations between mood and anxiety disorders with suicide were greatest within a year of treatment presentation.     

Generalized anxiety and panic disorders: Response to Cox, Cohen, Direnfeld, and Swinson (1996)

Contrary to the contention of Cox, Cohen, Direnfeld and Swinson (1996, Behaviour Research and Therapy, 34, 949–954) that the Beck Anxiety Inventory (BAI; Beck & Steer, 1993, Manual for the Beck Anxiety Inventory) measures primarily symptoms associated with panic attacks rather than anxiety in general, we propose that the higher level of anxiety found in patients with panic disorders not only is not an artifact of the BAI's symptom content, but patients with panic disorders truly have more anxiety than patients with other types of anxiety disorders. Furthermore, the BAI contains symptoms present in other anxiety disorders, besides panic disorder, and specifically includes 11 symptoms of generalized anxiety disorder (GAD). The BAI and revised Hamilton Anxiety Rating Scale (HARS-R; Riskind, Beck, Brown & Steer, 1987, Journal of Nervous and Mental Disease, 175, 474–479) scores of 274 (69%) outpatients with panic disorders and 123 (31%) outpatients with GAD were found to differentiate these two diagnostic groups equally and significantly. The panic disorder outpatients had higher scores on both the BAI and the HARS-R than did the GAD patients. Thus, Cox et al.'s (1996) speculation about the BAI's yielding spuriously high levels of anxiety in patients with panic disorders revives an important issue relevant to the relation of panic disorder to GAD.     

Better the Devil You Know? High-Risk Individuals’ Anticipated Psychological Responses to Genetic Testing for Melanoma Susceptibility

Purpose: The psychological consequences of genetic testing for mutations among individuals at increased risk of developing melanoma remain unexamined. The present study aimed to explore anticipated emotional, behavioral, cognitive, and familial responses to hypothetical genetic testing for melanoma susceptibility. Methods: Forty semi-structured interviews were undertaken with affected (n=20) and unaffected (n=20) individuals at either high or average risk of developing melanoma due to family history. Results: In-depth thematic analysis revealed that, in response to being identified as a mutation carrier, most participants with a family history anticipated calmly accepting their increased risk; either increasing precaution adoption or maintaining already vigilant behavioral practices; perceiving such information as important and valuable; and communicating genetic test results to family members, despite the acknowledgement of potential difficulties. In response to being identified as a non-carrier, the majority of participants expected to feel relieved; to maintain current precautionary health practices; to still perceive themselves at some risk of developing melanoma; and to be wary of the potential negative behavioral consequences of disclosing such information to family members. Women appeared more likely than men to acknowledge the potential for depression and worry following genetic testing. In contrast, more males than females expected to carry a gene mutation, and viewed their current preventive practices as optimum. Conclusion: Genetic testing for melanoma risk is likely to elicit a complex array of emotional, behavioral, cognitive, and familial responses for both testees and their family members, and these responses are likely to bear subtle differences for males and females.     

Reduced willingness to approach genuine smilers in social anxiety explained by potential for social evaluation,not misperception of smile authenticity

ABSTRACT

We investigate perception of, and responses to, facial expression authenticity for the first time in social anxiety, testing genuine and polite smiles. Experiment 1 (N?=?141) found perception of smile authenticity was unaffected, but that approach ratings, which are known to be reduced in social anxiety for happy faces, are more strongly reduced for genuine than polite smiles. Moreover, we found an independent contribution of social anxiety to approach ratings, over and above general negative affect (state/trait anxiety, depression), only for genuine smiles, and not for polite ones. We argue this pattern of results can be explained by genuine smilers signalling greater potential for interaction – and thus greater potential for the scrutiny that is feared in social anxiety – than polite smiles. Experiment 2 established that, relative to polite smilers, genuine smilers are indeed perceived as friendlier and likely to want to talk for longer if approached. Critically, the degree to which individual face items were perceived as wanting to interact correlated strongly with the amount that social anxiety reduced willingness to approach in Experiment 1. We conclude it is the potential for social evaluation and scrutiny signalled by happy expressions, rather than their positive valence, that is important in social anxiety.     

Board on Behavioral, Cognitive, and Sensory Sciences

Many of the key policy issues now facing the nation are behavioral in nature. Among these are educating and training citizens who can earn and keep jobs in a changing global economy; changing the behaviors that now cause half of all deaths in the country (e.g., smoking, poor diet and exercise patterns, and alcohol and drug abuse); reducing crime and violence; providing for an aging population; harnessing new information technologies to improve our quality of life; and reducing environmental pollution. These problems contrast with the defining policy challenges of the Cold War era, which demanded expertise primarily from the physical sciences.
Fortunately, the pressing need to solve behavioral problems arises at a time when rapid advances in behavioral, cognitive, and sensory sciences are improving our ability to address the problems. The time is ripe to strengthen the links between scientists and the policy community to harness new scientific advances to pressing public needs. To help forge these links, the National Research Council's (NRC) Commission on Behavioral and Social Sciences and Education (CBASSE) established a Board on Behavioral, Cognitive, and Sensory Sciences. This paper explains the need for this effort, and its potential. The report discusses the new promise of behavioral, cognitive, and sensory sciences, outlines the CBASSE record in these fields and its broadening focus on science-related policy questions; notes a range of emerging issues in which policy can benefit from expertise in these areas; and describes the functions of the new board.     

Children prenatally exposed to maternal anxiety devote more attentional resources to neutral pictures

Maternal anxiety during pregnancy can negatively affect fetal neurodevelopment, predisposing the offspring to a higher risk of behavioral and emotional problems later in life. The current study investigates the association between maternal anxiety during pregnancy and child affective picture processing using event‐related brain potentials (ERPs). Mothers reported anxiety during the second trimester using the anxiety subscale of the Symptom Checklist (SCL‐90). At age 4 years, child affective picture processing (N = 86) was measured by recording ERPs during viewing of neutral, pleasant, and unpleasant pictures selected from the International Affective Pictures System. The late positive potential (LPP)—an ERP component reflecting individual differences in affective processing—was used as child outcome. The expected positive association between maternal anxiety and LPP amplitude for unpleasant pictures was not found. Nevertheless, we found a positive association between maternal anxiety during pregnancy and LPP amplitudes for neutral pictures in the middle and late time window at anterior locations (all p < .05). These associations remained significant after adjusting for maternal postnatal anxiety and gestational age at birth and after FDR correction for multiple comparisons. Our study provides neurophysiological evidence that children prenatally exposed to higher maternal anxiety devote more attentional resources to neutral pictures, but not to unpleasant pictures. Possibly, these children show enhanced vigilance for threat when viewing neutral pictures. Although useful in dangerous environments, this enhanced vigilance may predispose children prenatally exposed to higher maternal anxiety to developing behavioral and/or emotional problems later in life. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=kEzYi6IS2HA     

焦虑对社会决策行为的影响

焦虑是在人类日常生活中常见的一种负性情绪。探讨焦虑情绪在个人生活和工作中扮演的角色, 是生理学界和心理学界的一项重要课题。过往研究显示焦虑水平的提高会对社会能力和社交技巧造成显著的影响。在社会决策领域中, 这种影响的具体表现是高焦虑者比低焦虑者更倾向于采取回避风险的策略。但是, 过往研究主要关心包含经济因素的社会决策, 而对其他类型的社会行为的探索存在不足。以下问题值得未来研究者们关注：在个体层面上, 高焦虑者是否会更容易受到外界信息的影响, 表现出更强的从众行为和权威依从倾向, 与他人进行社会比较或社会竞争的动机是否会被削弱？在群体层面上, 高焦虑者是否更容易表现出人际信任, 以及是否会表现出更强的服从集体倾向？考察这些问题将会为针对焦虑情绪的认知研究和临床研究起到促进作用。     

Ethical Issues Raised by Epigenetic Testing for Alcohol,Tobacco, and Cannabis

Epigenetic testing is one of the most significant new technologies to provide insight into the behavioral and environmental factors that influence the development and reconfiguration of the human genetic code. This technology allows us to identify structural changes in the genome that occur due to exposure to a wide variety of substances including alcohol, tobacco, and cannabis. The information gained can be used to promote health but it also raises a variety of ethical, legal, and social issues. As society progresses in understanding the epigenetic mechanisms of substance use and addiction, there is an opportunity to use these use this knowledge to enable medical, behavioral, and environmental interventions to alleviate the burden of addiction. This article describes the ethical issues associated with use of epigenetic testing for alcohol, tobacco, and cannabis and the implications of this technology. A further review of the scientific basis for the relevance of epigenetics is found in the accompanying article by Philibert and Erwin in this issue. Copyright © 2015 John Wiley & Sons, Ltd.     

Acceleration of the therapeutic process with group

This paper deals with the impact of adding group to individual treatment of patients with neurotic character problems and attempts to illustrate the efficacy of this dual approach. The formidable task for the individual therapist is to make these patients see that their habitual ways of reacting are pathological and stem from repressed intrapsychic conflicts. This task is facilitated in a group in a number of ways since the group setting becomes an arena that affords wider therapeutic scrutiny. Having become aware that behavioral characteristics disguise anxiety, other group members initiate independent efforts to extract the underlying meanings for their fellow members. Their interventions are often more effective and acceptable because they are less likely than the therapist to be perceived in the projected image of the bad parent.Copyright, 1980, Washington Square Institute for Psychotherapy and Mental Health, which published this paper in No. 7 of the Group Psychotherapy Monograph Series, after the paper had been presented at the Seventh Annual Conference of the Group Psychotherapy Department.     

Enduring without avoiding: Pauses and verbal dysfluencies in public speaking fear

Direct measures of overt behavior have been underutilized in speech and other social fear, anxiety, and phobia research. This study demonstrates the usefulness of such variables in the evaluation of public speaking fear. A molecular behavioral assessment methodology was used to examine pauses and verbal dysfluencies of individuals with circumscribed speech fear (n=8) or general social anxiety (n=8), as well as nonanxious control participants (n=16), during an impromptu speech behavior test. Speech fear and generally social anxious individuals paused more often and for a longer duration than the nonanxious group. Results also indicated greater increases in state anxiety during the speech in the circumscribed speech fear sample, relative to the generalized social anxiety and control groups. Taken together with other research, these findings provide evidence that circumscribed speech fear is a meaningful subtype and can be independent of generalized social anxiety. The utility of measuring pausing and verbal dysfluencies in the behavioral assessment of speech fear and other social anxiety and phobia is discussed.     

Collaborating With Pediatric Gastroenterologists to Treat Co-Occurring Inflammatory Bowel Disease and Anxiety in Pediatric Medical Settings

Children and adolescents with inflammatory bowel disease (IBD) have distinct physical and emotional challenges that may place them at risk for developing anxiety and that may impede their receipt of mental health treatment. Only a handful of studies have applied empirically validated cognitive behavioral therapy (CBT) to IBD-related issues and no studies have examined the benefit of CBT for anxiety disorders in pediatric IBD. The aim of this paper is to describe a newly adapted cognitive behavioral treatment protocol, Treatment of Anxiety and Physical Symptoms related to IBD (TAPS + IBD), that has been tailored to concurrently address anxiety, including IBD-specific anxiety, and disease management in children and adolescents with IBD in pediatric medical offices. Two case studies are presented to demonstrate treatment implementation and preliminary assessment data. General considerations for health providers working with youth with comorbid anxiety and IBD from a multidisciplinary perspective and future research directions are provided.     

Conceptual and methodological issues in the study of Internal Representation: A commentary on Infant Mental Health Journal,volume 10.3

This commentary raises issues about the current state of research on internal representation, using the Special Issue of the Infant Mental Health Journal on “Internal Representation and Parent-Infant Relationships” as a point of departure. Current research is praised for its emphasis on subjectivity and intersubjectivity in relationships, for integrating viewpoints from a variety of disciplines, and for the development of innovative investigatory approaches. At the same time, however, an overemphasis on quantitative methods is cited as possibly raising the risk of prematurely limiting an investigation of these issues that is broad-based enough to reflect their intricacy in actual experience. Instead, a more varied approach is sought, in which operationalizability is viewed as one of many potential sources of methodological validity rather than as the most important one. More purely clinical and theoretical approaches are particularly appropriate to the study of internal representation and intrafamilial relationships because access to personal, interior experience must rely on such forms as language and the techniques of clinical inquiry.     

Focus-of-attention behavioral experiment: an examination of a therapeutic procedure to reduce social anxiety

A clinical protocol based on contemporary cognitive behavioral treatment for social anxiety was developed and examined. Previously published instructions for conducting a focus-of-attention behavioral experiment targeting self-focused attention and safety behaviors during exposure were used to create a structured protocol. Individuals (n = 45) with high levels of social anxiety and public-speaking anxiety were randomly assigned to either a focus-of-attention behavioral experiment (FABE) or an Exposure-Only Control (EOC) condition. During four exposure trials, those in the FABE condition (n = 24) were alternately instructed to engage in self-focused attention vs. externally focused attention and to eliminate safety behaviors. Those in the EOC condition (n = 21) were not so instructed. At post-intervention, individuals in the FABE condition showed significantly less self-focused attention and anxiety, and better observed performance as rated by audience members. Focus-of-attention statistically mediated the effect of condition on anxiety. For those in the FABE condition, the degree of association between focus-of-attention and anxiety during the intervention predicted less self-focused attention post-intervention. The FABE appears to be a useful procedure for implementing part of the contemporary cognitive behavioral treatment model.     

Anxiety Disorders in Childhood: Casting a Nomological Net

Empirical research highlights the need for improving the childhood anxiety disorder diagnostic classification system. In particular, inconsistencies in the stability estimates of childhood anxiety disorders and high rates of comorbidity call into the question the utility of the current DSM criteria. This paper makes a case for utilizing a nomological net⁴ model for advancing the understanding of childhood anxiety disorders. In this article, we discuss measurement and assessment issues related to improving the childhood anxiety disorder diagnostic system and show how these issues can be addressed by employing the nomological net of childhood anxiety. Because employing the nomological net involves drawing from etiological process theories to facilitate classification and assessment, an integrative model of childhood anxiety disorders is presented as a tentative heuristic. Then evidence for the existing symptom sets is discussed in the context of how process theory mechanisms may be utilized to improve classification and assessment. Testable hypotheses are presented. Measurement, disorder definition, treatment, and policy implications are also discussed.A nomological net can be briefly defined as the theoretical structure of a construct.     

Conceptual,methodological, and clinical issues in cognitive-behavioral assessment

This article reviews cognitive-behavioral assessment principles and procedures. The functions of such assessments are noted, and issues and advances in cognitive assessment are discussed. The need for integrated cognitive, behavioral, and affective assessments is then explored. Finally, conceptual methodological, and clinical issues in the integration of assessments and study of reciprocal determinants are presented.Preparation of this paper was supported in part by a General Research Board Faculty Research Award from the University of Maryland. The author would like to thank Steve Graham, Donald Meichenbaum, Barbara Keogh, and Bernice Wong for their feedback during the preparation of this paper.