A preliminary investigation of cognitive and relaxation treatment of panic disorder: effects on intense anxiety vs 'background' anxiety

In this study, three adult males complaining of Panic Disorders were treated with cognitive therapy followed by relaxation training combined with cognitive therapy in a multiple-baseline across Ss design. All Ss demonstrated a decrease in the number and duration of episodes of heightened or intense anxiety, which was maintained at 3-month follow-up. Daily time-sampled ratings of ‘background’ anxiety, not necessarily associated with periods of intense anxiety, showed a substantial decrease for S2, which was maintained at 3-month follow-up. However, S 1 and S 3 evidenced an increase in background anxiety during the combined treatment phase in contrast to the effects of treatment on periods of ‘intense’ anxiety. These results suggest that psychological treatments for patients classified as suffering from Panic Disorder are effective and lend some support to the differentiation of panic from ‘general’ anxiety. Recent observations of relaxation-induced anxiety were also replicated in this clinical setting. These data also illustrate the advantages and difficulties of self-monitoring anxiety over a period of time.     

Provocation of panic: three elements of the panic reaction in four anxiety disorders

Subjects with agoraphobia (N = 25), panic disorder (N = 25), social phobia (N = 19) or generalized anxiety disorder (N = 10) and controls with no psychiatric history (N = 16) underwent two provocation tests, voluntary hyperventilation and inhalation of 5% CO2 in air, and three experimental control conditions. They were measured on three elements of the panic reaction: somatic symptoms, psychic anxiety and fears of impending doom, and on a standard YES/NO measure of panic attack. The provocation conditions produced increased somatic symptoms and psychic anxiety across all groups relative to the control conditions. The agoraphobic and panic disorder groups showed a significantly greater increase in fears of impending doom from control to provocation conditions than the social phobic and GAD patients. This difference was not observed on measures of somatic symptoms or psychic anxiety. The present results provide some support for the theory that panic attacks result from the catastrophic misinterpretation of anxious symptoms, in this case produced by the two provocation tests.     

Effects of anxiety sensitivity on anxiety and pain during a cold pressor challenge in patients with panic disorder

Fear of anxiety symptoms, or anxiety sensitivity (AS), has been extensively studied in anxiety disorders and more recently has been linked to other psychopathological conditions including pain. Asmundson and colleagues have suggested that AS may act as a risk factor for chronic pain and several studies have demonstrated an association between AS, avoidance behaviors and pain. The present study assessed whether AS levels would be predictive of pain and anxiety during a brief pain induction task. Clinical participants meeting DSM-IV criteria for panic disorder (n = 22) were age and sex matched with nonclinical controls (n = 22) and exposed to a 2-min cold pressor challenge. Diagnostic status and AS were significantly predictive of pain and anxiety during the cold pressor task. Moreover, AS appears to mediate the relationship between diagnostic status and pain. However, AS appears to be only indirectly associated with pain through its contribution to anxiety.     

Mechanisms of change in cognitive behavioral therapy for panic disorder: The unique effects of self-efficacy and anxiety sensitivity

The present study examined temporal dependencies of change of panic symptoms and two promising mechanisms of change (self-efficacy and anxiety sensitivity) during an 11-session course of cognitive-behavior therapy (CBT) for Panic Disorder (PD). 361 individuals with a principal diagnosis of PD completed measures of self-efficacy, anxiety sensitivity, and PD symptoms at each session during treatment. Effect size analyses indicated that the greatest changes in anxiety sensitivity occurred early in treatment, whereas the greatest changes in self-efficacy occurred later in treatment. Results of parallel process latent growth curve models indicated that changes in self-efficacy and anxiety sensitivity across treatment uniquely predicted changes in PD symptoms. Bivariate and multivariate latent difference score models indicated, as expected, that changes in anxiety sensitivity and self-efficacy temporally preceded changes in panic symptoms, and that intraindividual changes in anxiety sensitivity and self-efficacy independently predicted subsequent intraindividual changes in panic symptoms. These results provide strong evidence that changes in self-efficacy and anxiety sensitivity during CBT influence subsequent changes in panic symptoms, and that self-efficacy and anxiety sensitivity may therefore be two distinct mechanisms of change of CBT for PD that have their greatest impact at different stages of treatment.     

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.     

场景对面孔情绪探测的影响：特质性焦虑的调节作用

本研究采用面孔情绪探测任务, 通过状态-特质焦虑问卷筛选出高、低特质性焦虑被试, 考察场景对不同情绪效价以及不同情绪强度的面部表情加工的影响, 并探讨特质性焦虑在其中所发挥的作用。结果发现：(1)对于不同情绪效价的面部表情, 场景对其情绪探测的影响存在差异：对于快乐面部表情, 在100%、80%和20%三个情绪层级上, 在场景与面孔情绪性一致情况下, 被试对面孔情绪探测的正确率显著高于不一致情况; 对于恐惧面部表情, 在80%、60%、40%和20%四个情绪层级上, 均发现一致条件比不一致条件有着更高的情绪探测正确率。(2)对于高特质性焦虑组, 一致条件和不一致条件中的面孔情绪探测正确率并没有显著差异, 即高特质性焦虑组并未表现出显著的场景效应; 而低特质性焦虑组则差异显著, 即出现显著的场景效应。该研究结果表明：(1)对于情绪强度较低的面部表情, 快乐与恐惧面孔情绪探测都更容易受到场景的影响。(2)相比于中等强度快乐面孔, 场景更容易影响中等强度恐惧面孔情绪的探测。(3)特质性焦虑的个体因素在场景对面孔情绪探测的影响中发挥调节作用, 高特质性焦虑者在情绪识别中较少受到场景信息的影响。     

The observer perspective: effects on social anxiety and performance

The cognitive model of social phobia by Clark and Wells (Social phobia : Diagnosis, Assessment and treatment (1995)) proposes that individuals with social phobia generate a negative impression of how they appear to others, constructed from their own thoughts, feelings and internal sensations. This impression can occur in the form of a visual image from an external, or "observer", perspective. Although social phobics use this perspective more than controls, the impact of the observer perspective has not been tested experimentally. This study investigated the effects of taking the observer perspective on thinking, anxiety, behaviour and social performance in high and low socially anxious participants. Forty-four participants (N=22 in each group) gave two speeches, one in the observer and one in the field perspective. Use of the observer perspective produced more frequent negative thoughts, more safety behaviours, and worse self-evaluation of performance in both groups. There were also clear trends demonstrating increases in anxiety and in thought belief ratings in the observer perspective compared to the field perspective. Results are consistent with the Clark and Wells model of social phobia. This study also suggests that in low socially anxious individuals, the observer perspective may contain positive information.     

Cognitions in generalized anxiety disorder and panic disorder patients. A prospective approach.

Self-observations of cognitions during episodes of anxiety were examined in 38 patients with generalized anxiety disorder and 36 patients with panic disorder. Two independent observers who where blind to the diagnoses categorised the cognitions. The inter-rater reliability was high (mean kappa 0.82). The GAD-patients had significantly more cognitions in the following categories: interpersonal confrontation, competence, acceptance, concern about others and worry over minor matters, while the PD-patients had significantly more cognitions in the physical catastrophe category. Furthermore, GAD-patients with a comorbidity of social phobia reported more cognitions regarding social embarrassment than did GAD-patients with other or no (axis-I) comorbidity. The results of this study support the cognitive theory regarding the cognitive specificity of anxiety disorders. The implications of these results are discussed, along with the issues of reliability and validity of the instrument used.     

The hyperventilation syndrome in panic disorder, agoraphobia and generalized anxiety disorder

The symptom complex of panic disorder and generalized anxiety disorder suggests an etiological role for hyperventilation. The present study investigates the overlap between DSM-III-R panic disorder, panic disorder with agoraphobia and generalized anxiety disorder with hyperventilation syndrome (HVS). The anxiety disorder diagnoses were based on a structured interview, and HVS syndrome (HVS). The anxiety disorder diagnoses were based on a structured interview, and HVS determined by the so-called hyperventilation provocation test (a brief period of voluntary hyperventilation with recognition of symptoms). The overlap rates with HVS were: 48% for panic disorder, 83% for panic disorder with agoraphobia and 82% for generalized anxiety disorder. However, a pilot study on transcutaneous monitoring of carbon dioxide tension leads us to question the validity of the voluntary hyperventilation method that we used to determine HVS-status. It is unclear whether hyperventilation plays an important role in panic and general anxiety, as our overlap findings suggest. For patients who recognize the symptoms induced by voluntary hyperventilation, the hyperventilation provocation procedure provides a therapeutic means of exposure to feared bodily sensations.     

The effects of ethanol intoxication on phobic anxiety

Behavioral conceptions of alcohol abuse often include the hypothesis that drinking behavior is a negatively reinforced operant, with ethanol intoxication viewed as alleviating aversive environmental and internal states. This hypothesis has not been confirmed or refuted by previous studies which employed mild stressors and limited assessment methodology. In the present experiment, 22 patients with severe phobias approached their phobic animal under two consecutive conditions—first while sober and second after drinking either a placebo or an intoxicating dose of ethanol. The severe anxiety induced was assessed behaviorally, physiologically and by the patient's self-report of fear. The intoxicated patients did not experience decreased anxiety, tachycardia or avoidance, compared to the placebo group. These results have clinical implications and suggest the need to reconsider tension-reduction theories of alcohol abuse.     

The effects of safety behaviors on health anxiety: an experimental investigation

The present study examined the extent to which safety behaviors exacerbate symptoms of hypochondriasis (severe health anxiety). Participants were randomized into a safety behavior (n = 30) or control condition (n = 30). After a baseline period, participants in the safety behavior condition spent one week actively engaging in a clinically representative array of health-related safety behaviors on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of safety behaviors. Compared to control participants, those in the safety behavior condition reported significantly greater increases in health anxiety, hypochondriacal beliefs, contamination fear, and avoidant responses to health-related behavioral tasks after the safety behavior manipulation. In contrast, general anxiety symptoms did not significantly differ between the two groups as a function of the manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related thoughts mediated the effects of the experimental manipulation on health anxiety. These findings suggest that safety behaviors are associated with increases in health anxiety, perhaps by fostering catastrophic thoughts about health. The implications of these findings for the conceptualization of hypochondriasis as an anxiety disorder are discussed.     

安全依恋对人际信任的影响:依恋焦虑的调节效应

采用两个实验探讨了安全依恋启动对人际信任的影响,并考察了特质依恋风格的调节效应。实验1采用回忆书写任务启动安全依恋,采用3(启动分组:安全依恋启动,积极情绪启动,中性启动)×3(目标词类型:信任相关词,信任无关词,非词)混合实验设计考察了不同启动分组对信任词汇反应时的影响。结果发现,与积极情绪启动组和中性启动组相比,安全依恋启动能显著提高信任的词汇决策反应时,特质依恋焦虑起调节效应。实验2采用被试间设计,考察安全依恋启动对信任博弈任务中信任决策的影响,结果发现,安全依恋启动组被试在信任决策中分配的金额显著高于中性组被试,特质依恋焦虑起调节效应。研究结果验证了安全依恋对人际信任的"拓延–建构环"效应,对于促进社会信任的提升具有积极的现实意义。     

The effects of language conditioning on various aspects of anxiety

Staats' three-function learning theory provides the basis for investigating the effects of emotionally-relevant self-verbalizations (SV) on the physiological, subjective-affective and behavioural aspects of anxiety. Using aversive electric UCSs and slides of snakes (CS), anxiety was classically conditioned in 88 volunteer Ss. In 20 subsequent language-conditioning trials (without aversive electric UCSs), the same snakes slides were paired with UCS verbalizations having either positive or negative connotative meanings. Half of the Ss were exposed to a living snake prior to language conditioning. The results show a complete extinction of the conditioned anxiety response in groups with positive SV whereas negative SV impeded extinction; the latter effect could only be found in groups without exposure to snakes prior to language conditioning. In general, the affective evaluation of snakes improved in groups with positive SV and deteriorated in groups with negative SV. However, these effects were more pronounced in groups without exposure to snakes. Although the results indicate that Ss in all groups with positive SV exhibited more approach behaviours than Ss with negative SV, this trend was not statistically significant. The possible relevance of the results for a language-conditioning approach to anxiety reduction is briefly discussed.