Blood/injury fear, fainting and avoidance of medically-related situations: a family correspondence study

The relationship of mutilation fear and fainting was examined in 204 students, (103 fainters and 101 non-fainters) by administering a series of questionnaires and a structured interview concerning the history, effects and circumstances of their fear and fainting. Two hundred and sixty of their parents completed the same scales along with a self-report version of the structured interview. Subjects were classified according to their fainting status and level of fear based on Mutilation Questionnaire scores, as phobic, fearful, and non-fearful fainters, and fearful non-fainters. Phobic and fearful fainters avoided significantly more medical and related situations due to their fear and fainting than fearful non-fainters and non-fearful fainters. Medical avoidance was best predicted by a linear combination of subjects' estimated probability of future fainting and number of past faint episodes. More females reported fainting and females reported greater fear, but they did not differ from males in fear-motivated avoidance of medical situations. A significant parent-child correspondence was found for fainting, but not for fear nor for avoidances. Implications of these findings for fear and fainting acquisition and its relation to avoidance were discussed.     

General and specific fears in referred and self-referred adult patients with extreme dental anxiety.

The levels of, and relationships between, dental fear and general fears and phobias were studied in 109 adult patients at a specialized dental fear clinic using two dental fear scales (the Dental Anxiety Scale and the Dental Fear Survey) together with the Fear Survey Schedule II (FSS-II) and some additional fear items. Referred and self-referred fearful dental patients answered mailed questionnaires in conjunction to being put on a 1 yr waiting list for treatment. Among feared objects and situations the separate item 'pain' revealed the highest mean scores for both men and women, followed by fear of suffocating, death of a loved one and sharp objects among women, and death of a loved one, suffocating and hypodermic needles among men. With few exceptions, women scored higher than men. The frequencies of extreme fears (6 and 7 on a 7-point scale) were high and 92.7% of the patients reported at least one extreme fear. Half of the subjects (49.5%) reported five fears or more. It was also shown that a number of FSS-II items correlated to dental fear indicating a relationship between general and dental fear. These results indicated that a large proportion of these dentally fearful individuals were prone to fear-associated reactions and behaviors, which has previously been shown to negatively influence the prognosis of treatment.     

Fear survey schedule (II): Normative data and factor analyses based upon a large college sample

A fear survey schedule (FSS-II) was administered to 1814 undergraduates at the University of Illinois. Females reported significantly more fear than males. Factor analyses indicated that FSS-II taps the following major fear areas: Live Organisms, Death and Illness, Social Interaction, and Social Evaluation. Problems associated with the use of FSS-II total scores for subject selection purposes and with the unsupplemented use of verbal report fear measures were discussed.     

Blood and injection phobia: background and cognitive, physiological, and behavioral variables.

Blood-phobic (n = 81) and injection-phobic (n = 59) patients fulfilling the DSM-III-R criteria for simple phobia were compared on a number of variables. There were no differences between the samples in age at onset, age at treatment, marital and occupational status, history of fainting in the phobic situation, and impairment. Higher proportions of blood-phobic subjects than of injection-phobic subjects reported having first-degree relatives with the same phobia (61% vs. 29%) and reported fearing that they were going to faint in the phobic situation (77% vs. 48%). In both samples, these proportions were higher in the subgroup with a history of fainting. Injection-phobic subjects rated 2 of 11 physiological items higher than did blood-phobics subjects, but the groups did not differ on behavioral variables. Overall, the similarities were more marked than the differences, and it is suggested that these two specific phobias should be regarded as one diagnostic entity.     

Further investigation of the relationship between expressed social fear and assertiveness

Recently, Morgan (1974) investigated the relationship between expressed social fear and assertiveness. As hypothesized, Morgan found a statistically significant relationship between social fear as measured by ten items from the Fear Survey Schedule-III (FSS-III) (Wolpe and Lang, 1964) and assertiveness as measured by the Rathus Assertiveness Schedule (RAS) (Rathus, 1973b). The observed relationship, however, was of little predictive importance, as noted by Morgan, in that the Pearson product-moment correlation coefficients accounted at most for less than 6 per cent of the variance. This finding raises questions concerning traditional views of assertiveness (e.g. Salter, 1949; Wolpe 1958; Wolpe and Lazarus, 1966) which have hypothesized that an individual is “inhibited from the performance of ‘normal’ behavior because of neurotic fear” (Wolpe, 1973, p. 81).The literature concerning the relationship between assertive behavior and social fear is meager. Goldstein, Serber and Piaget (1970) have reported two illustrative case studies in which anger expressiveness induced through assertiveness training resulted in the clinically assessed reduction of social fear. Rathus (1973a) has reported the results of an empirical investigation of assertiveness training which might, as suggested by Morgan, lend indirect support for the hypothesized relationship. Using undergraduate female subjects, Rathus found that an assertive training group not only scored higher on a measure of assertiveness—the RAS—at post-testing than either the placebo or the no-treatment groups, but the training group also reported a nonsignificant tendency of being less fearful than the other two groups of social criticism and social incompetence, as measured by the Temple Fear Survey (Braun and Reynolds, 1969).Weinman et at. (1972) administered the Fear Survey Schedule-II (FSS-II) (Geer, 1965) to a sample of hospitalized patients diagnosed as schizophrenic. The FSS-II consists of 51 fear items, 13 or 25.9% of which can be considered to be interpersonal in nature. All three treatment conditions—socioenvironmental, desensitization, and relaxation therapy—resulted in a significant decrease in reported fear (p < 0.001).Bates and Zimmennan (1971) during the initial stages of constructing their Constriction Scale (CS) administered the CS and the FSS-II. The term ‘constriction’, incidentally, was used by the authors to “denote non-assertion” (p. 100). Unlike the RAS, a high score on the CS denotes low assertiveness. Correlation coefficients for the CS with the FSS-II of 0.32 for the male sample and 0.13 for the female sample were obtained. The male coefficient was significant at the 0.05 level. These findings may be confounded, as in the case of Weinman et al. (1972), by the inclusion of fear items on the FSS-II unrelated to interpersonal behavior, such as Thunderstorms' and ‘Hypodermic needles’.Morgan (1974) attacked the problem more directly. Drawing on several factor analytic studies of various fear schedules, Morgan constructed a 10-item Social Fear Scale (SFS) from the FSS-III. Using a large, undergraduate sample (n = 261), Morgan reported correlation coefficients for the RAS with SFS of-0.17 for the male sample, ?0.20 for the female sample, and ?0.24 for the sample as a whole.Whereas the magnitude of the correlation coefficients reported by Bates and Zimmerman (1971) may have been attenuated by the inclusion of items unrelated to social situations, Morgan's results may have been attenuated by the tapping of only limited aspects of social fear. Morgan reported that in the construction of the SFS, “The items selected were those which most consistently loaded heavily on ‘social fear’ factors and did not load heavily on other factors” (1974, p. 255). Inspection of FSS-III items not included in the SFS, however, indicated that several had been excluded which may be conceptualized as relevant to assertive behavior, such as ‘Speaking in public’, ‘Feeling angry’, and ‘People in authority’.It is suggested that an expanded SFS which would include all items from the FSS-III conceptually compatible with assertiveness might result in findings of greater predictive value. One purpose of this study is the replication of the Morgan (1974) study. In addition, however, a more comprehensive SFS and another measure of assertiveness will be used to further investigate the relationship between assertiveness and social fear. It is hypothesized that the expanded SFS will correlate inversely with both self-report measures of assertiveness to a degree significantly greater than the correlations of the two measures with the original SFS.     

Specific fears as predictors of generalized anxiety

Three hundred thirty-seven female undergraduates completed the Trait Form of the State-Trait Anxiety Inventory (STAI) and the Fear Survey Schedule-II (FSS) to determine if any specific fear factor was significantly related to STAI score. All fear factor scores and the total FSS-II score were significantly correlated with the STAI score and with each other. A stepwise regression procedure indicated that Factor 1, Fear of Social Interaction, accounted for 25.2% of the variance in STAI scores (p <.001), while Factor 4, of Negative Social Evaluation, accounted for an additional 1.8% of the variance (p <.01). The implications for theory, assessment, and intervention are discussed.     

Manifestations, acquisition and diagnostic categories of dental fear in a self-referred population

This study aimed to clarify how manifestations and acquisition relate to diagnostic categories of dental fear in a population of self-referred dental fear patients, since diagnostic criteria specifically related to dental fear have not been validated. DSM III-R diagnostic criteria for phobias were used to compare with four existing dental fear diagnostic categories, referred to as the Seattle system. Subjects were 208 persons with dental fear who were telephone interviewed, of whom a subsample of 155 responded to a mailed Dental Anxiety Scale (DAS), State-Trait Anxiety Inventory and a modified FSS-II Geer Fear Scale (GFS). Personal interviews and a Dental Beliefs Scale of perceived trust and social interaction with dentists were also used to evaluate a subsample of 80 patients selected by sex and high dental fear. Results showed that the majority of the 80 patients (66%), suffered from social embarrassment about their dental fear problem and their inability to do something about it. The largest cause of their fear (84%) was reported to be traumatic dental experiences, especially in childhood (70%). A minority of patients (16%) could not isolate traumatic experiences and had a history of general fearfulness or anxiety. Analysis of GFS data for the 155 subjects showed that fear of snakes and injuries were highest among women; heights and injections among men. Fear of blood was rarely reported. Spearman correlations between GFS individual items and DAS scores indicated functional independence between dental fear and common fears such as blood, injections and enclosures in most cases. Only in specific types of dental fear did these results support Rachman and Lopatka's contention that fears are thought to summate.(ABSTRACT TRUNCATED AT 250 WORDS)     

Psychophysiologic effects of applied tension on the emotional fainting response to blood and injury

OBJECTIVE: The present study was designed to investigate the psychophysiologic effects of "Applied Tension" (AT) on the emotional fainting response to blood and injury in a controlled experiment. METHOD: Twenty-two persons reporting to generally feel faint or to have fainted at the sight of blood or injury and 22 participants classified as Non-Fainters were randomly allocated to a treatment or control condition. Psychophysiologic responses were continuously monitored while individuals watched a video depicting open-heart surgery and a control film. Prior to the surgery film, participants in the treatment condition were instructed in the use of AT. RESULTS: All participants classified as Fainters showed a diphasic response pattern while watching the surgery film. This response, however, was significantly attenuated in Fainters in the treatment condition. CONCLUSIONS: These results suggest that AT provides an effective treatment strategy for the prevention of fainting responses in persons with a fear of blood and injury.     

False physiological feedback and persuasion: Effect of fear arousal vs. fear reduction on attitude change

Two experiments tested the hypothesis that increases in false physiological feedback of fear arousal will enhance persuasion and that reduction in the arousal feedback is unnecessary for increased persuasion to occur. Prior research has usually found a positive relation between level of arousal and persuasion, but support for the drive reduction hypothesis is tenuous. However, Harris and Jellison (1971) claimed support for such a hypothesis. They manipulated subjects' fear arousal cognitively via false physiological feedback while the subjects listened to a persuasive communication. The present experiments used a similar procedure in an attempt to test an "arousal only" against an "arousal reduction" hypothesis. Subjects listened to a persuasive speech while receiving false feedback via a meter concerning their fear arousal. In Experiment I half of the subjects received high arousal and half received moderate arousal information. Within each of these conditions half of the subjects had their arousal reduced, and the other half did not. In Experiment II subjects received either low arousal, high arousal, or high then low arousal feedback while listening. The results of the two studies generally provided support for the "arousal only" hypothesis. An interpretation in terms of Bem's attribution theory was tentatively suggested.     

The role of disgust and fear in blood and injection-related fainting symptoms: A structural equation model

Structural equation models were used to examine the relationship of blood, injection, and injury (BII) fears, disgust sensitivity, and trait anxiety to having experienced fainting-related symptoms in 722 university students. The latent variable representing BII fears was highly positively related to faint symptoms whereas that relating to disgust experiences was inversely related to fainting. A second disgust sensitivity variable was not directly related to fainting. Trait anxiety added nothing directly to the model, although it was related to BII latent variable. Additional analyses included a gender-related cross-validation which showed that models developed on one gender group did not fit well when applied to the other gender group. Blood drawings were the most common faint eliciting situations and were found to be reportedly more likely to elicit faint symptoms than were injections.     

Validation of the Multidimensional Blood/Injury Phobia Inventory: Evidence for a Unitary Construct

The Multidimensional Blood/Injury Phobia Inventory (MBPI) was developed from a theoretical framework to characterize a broad range of feared stimuli and phobic reactions associated with this pathology. The MBPI consists of 40 items that cross 4 types of stimulus content (injections, hospitals, blood, injury), 5 types of phobic responses (fear, avoidance, worry, fainting, disgust), and a self versus other focus. This study reports on administration of the MBPI to 558 undergraduates, 9 of whom had blood/injury phobia. The instrument had a Cronbach's alpha of .91 and demonstrated good concurrent validity, convergent validity, and discriminant validity. One large factor emerged in an unrotated principal components analysis, suggesting that blood/injury phobia is a unitary psychometric construct. Exploratory factor analyses revealed a 6-factor solution defined by stimulus content domains and fainting, each of which may be important to consider clinically when assessing the unique concerns of treatment-seeking individuals.     

Effects of physical threat and ego threat on eating behavior

Restrained and unrestrained subjects were subjected to one of three distress manipulations prior to an ad lib taste task. The physical fear threat (anticipated electric shock) significantly decreased unrestrained subjects' eating and slightly increased restrained subjects' eating. Both ego threats (failure at an easy task or anticipating having to give a speech in front of an evaluative audience) significantly increased restrained subjects' eating but did not significantly suppress unrestrained subjects' eating. This pattern supports the proposition that physical fear differs from more general dysphoria in its effects on eating, perhaps because of the divergent effects of these two types of distress on eating control mechanisms, which in turn differ in restrained and unrestrained eaters.     

Development and Initial Validation of an Abbreviated Spider Phobia Questionnaire Using Item Response Theory

An abbreviated Spider Phobia Questionnaire (SPQ) was developed using methods based in item response theory. Fifteen of the 31 SPQ items that demonstrated good to excellent discrimination along the spider fear continuum were retained in Study 1 that consisted of 1,555 nonclinical and clinical participants. The SPQ-15 demonstrated good internal consistency and correlated highly with the full SPQ. Structural equation modeling revealed that the SPQ-15 demonstrated excellent convergent validity, with strong associations with small animal disgust and other phobic symptoms. Supportive evidence was also found for divergent validity in relation to panic-related symptoms. The SPQ-15 was uniquely predictive of avoidance behavior and fear and disgust responding towards spiders in nonclinical, analogue, and treatment-seeking samples in Studies 2, 3, and 4. Lastly, in Study 5, the SPQ-15 was sensitive to the effects of exposure-based treatment. These findings suggest that the SPQ-15 has considerable strengths, including decreased assessment and scoring time while retaining high reliability, validity, and sensitivity.     

Factor analysis of the 122 item fear survey schedule

The 122 item fear survey schedule was factor analyzed in an attempt to discover whether various stimuli cluster together in their capacity to evoke anxiety. The method of factor analysis involved a rotation to an oblique structure with the result that 5 conceptually pure factors emerged accounting for at least 90 per cent of the variance. The factors were named as follows: (1) fears related to small animals, (2) fears of the precipitators and manifestations of hostility, (3) moralistically related fears and sexual fears, (4) fears of isolation and loneliness, and (5) fears of anatomical destruction and physical pain. Using the items that correlated 0.35 or better with factors, a 40 item fear survey schedule emerged. Suggestions for clinical use of this fear survey schedule were made.     

Interpersonal Hostility Assessment Technique: Description and Validation Against the Criterion of Coronary Artery Disease

High levels of hostility are associated with adverse health outcomes. The Interpersonal Hostility Assessment Technique (IHAT; Barefoot, 1992) measures hostility from verbal behavior during a standardized interview. Four types of behaviors are scored as hostility: evading the question, irritation, and indirect and direct challenges to the interviewer. The sum of the frequencies of these acts is a Hostile Behavior Index (HBI), which is divided into two components: verbal, scored with speech content in mind, and paraverbal, based on vocal stylistics. This study examined characteristics of IHAT assessments in 129 male coronary patients. Satisfactory interrater reliabilities were obtained. The HBI correlated highly (.58) with coronary artery disease severity after controlling for traditional risk factors. This relation was not affected by question topic or by differential weighting of the four hostile, behaviors. Both HBI components were significantly correlated with disease. Results are discussed in terms of their implications for hostility assessment.     

A Protective Factor Against Mental Health Problems in Youths? A Critical Note on the Assessment of Self-Compassion

Self-compassion, which refers to the tendency of being kind and understanding to oneself when confronted with personal failings and difficulties, is increasingly investigated as a protective factor within the context of mental health problems. In this invited paper, I will briefly introduce the concept of self-compassion and give an overview of the research that has examined its relationship with psychopathology in youth. Then I will make my critical point regarding the assessment of self-compassion: the scales that are currently used for measuring this construct include a large number of reversely scored, negative items that measure the precise opposite of having compassion with oneself. I present evidence (partly on the basis of own data) that these negative items do not reflect the true protective nature of self-compassion and tend to inflate the relation with psychopathology. My recommendation is to remove the negative items from the scales and to assess self-compassion by means of a set of items that truly reflect its protective nature.     

On the diphasic nature of vasovagal fainting associated with blood-injury-illness phobia

A detailed psychophysiologic analysis of a vasovagal faint occurring in a “blood-injury-illness” phobic demonstrated that the syncopal episode consisted of a diphasic response. This lends support to the hypothesis that vasovagal fainting in these patients is caused by an overcompensating rebound parasympathetic activation following sympathetic arousal. Treatment and research implications of this finding are discussed.     

Cultural effects on the expression of some fears by Chinese and British female students

To compare the culturally acquired aspects of fears in two different cultures, the author gave an augmented version of the I. M. Marks and A. M. Mathews Fear Scale (1979) to 50 female students in China and 49 female students in England. When the rank ordering of the fears measured in both groups was compared, the author found a high positive correlation, suggesting cross-cultural consistencies in the ranking of fearful objects. Both groups most feared social criticism and appraisal by others, followed by fears of blood, pain, and injury. The students feared least aspects related to agoraphobia. When the expressed levels of fear were compared, the Chinese students had significantly lower fear scores for many items. The reasons for those scores are discussed in terms of lower actual fear levels, moderating response sets, or socialization practices. The fears that showed no cultural differences were the ones that had early biologically relevance, such as fear of the dark and of high places. Only the socially learned fears showed cultural differences.     

Confidence judgments in studies of individual differences

This paper examines psychometric properties of scores derived from calibration curves (overconfidence, calibration, resolution, and slope) and an analogue of overconfidence that is based on a posttest estimate of the proportion of correctly solved items. Four tests from the theory of fluid and crystallized intelligence were used, and two of these tests employed both sequential and simultaneous methods of item presentation. The results indicate that the overconfidence score not only has the highest reliability, but is the only score with a reliability normally considered adequate for use in individual differences research. There is some, albeit weak, difference in subjects' level of overconfidence between sequential and simultaneous methods of item presentation. Correlational evidence confirms our previous findings that overconfidence scores from perceptual and ‘knowledge’ tasks define the same factor. In agreement with the results of Gigerenzer, Hoffrage and Kleinbolting (1991), subjects' post-test estimates of their performance showed lower levels of overconfidence than did the traditional measures based on subjects' confidence judgment responses to individual items. Also, after controlling for the actual test performances, the post-test performance estimates and average confidence ratings were only slightly positively correlated, suggesting that different psychological processes may underlie these two measures. Finally, our results suggest that average confidence over all items in the test may be a more useful measure in individual differences research than scores derived from calibration curves.     

Comparison between FSS-II scores of two groups of university students sampled 15 yr apart.

Undergraduate students were contacted in classes at Memorial University of Newfoundland during 1975 and asked to complete the FSS-II, on a voluntary basis; 511 students (232 male and 279 female subjects) provided enough data for analyses. In 1990, the same procedure was carried out, resulting in a comparable group of 359 students (161 male and 198 female subjects). Contrary to predictions, the 1990 students were more fearful than the 1975 group and the increase in fearfulness was contributed exclusively by women students. The component of fear contributing most to this increase related to social evaluation and violence.