Influence of obstetrical events on satisfaction and anxiety during childbirth: a prospective longitudinal study

The aim of this study was to investigate the feelings of anxiety and satisfaction among 79 primiparas who had uncomplicated pregnancies, at the time of hospital admission and after birth, considering the mode of delivery, analgesia, and pain levels. Questionnaires were completed at admission to the hospital and two months after delivery, using the State-Trait Anxiety Inventory (STAI) state scale and the Labour Agentry Scale. The mean (SD) STAI state score was higher at admission (36.7 (10.7)) than 4 months after childbirth (32.1 (9.7)) (paired Student’s t-test, t = 2.93; df = 78; p = .004). However, the postnatal anxiety was not associated with the mode of delivery, epidural or pain. Regarding the satisfaction with the expectations of control during childbirth, the mean (SD) score was higher before childbirth (166.0 (21.8)) than after (157.5 (33.5)) (paired Student’s t-test, t = ?2.28; df = 77; p = .03). The satisfaction with the childbirth experience was significantly associated with the expectations of childbirth and the mode of delivery, but not with analgesia or pain. The postnatal anxiety was associated with physical health, pain and the Edinburgh Postnatal Depression Scale score during the postpartum period. It is important to consider the temporality of perinatal anxiety in order to understand its causes. Our results indicate that the experience of childbirth was predicted in this sample by the antenatal expectations and delivery outcomes.     

Pre- and Postpartum Fear of Childbirth in Nulliparous and Parous Women

The link between fear of childbirth and theories of anxiety in general is discussed. A possible expression of trait (T-fear) and state (S-fear) aspects of fear of childbirth was investigated in 77 nulliparous and 85 parous women based on data from gestational week 32, at 2 hours and at 5 weeks after childbirth. Data are based on the State Trait Anxiety Inventory and the Wijma Delivery Expectancy/Experience Questionnaire. According to their scores on the Wijma Delivery Expectancy/Experience Questionnaire during late pregnancy, women were divided into 3 groups: high, moderate and low levels of fear of childbirth. In gestational week 32, women in the low level of fear of childbirth group had lower trait anxiety than those in the moderate level of fear of childbirth group, who had lower trait anxiety than the women in the high level of fear of childbirth group. Nulliparous women had a higher level of fear of childbirth but a lower level of trait anxiety than did parous women. There was a significant decreasing trend in fear of childbirth from 2 hours to 5 weeks after delivery, in a parallel way for all 3 groups. Differences in fear of childbirth between nulliparous and parous women disappeared after delivery. These findings suggest that fear of childbirth comprises a considerable part of T-fear, with the risk of a vicious cycle, i.e. that during labour women experience what they are afraid of, which also influences the women's postpartum cognitive appraisal of the delivery.     

Predicting anxious response to a social challenge: the predictive utility of the social interaction anxiety scale and the social phobia scale in a college population

Trait anxiety is believed to be a hierarchical construct composed of several lower-order factors (Adv. Behav. Res. Therapy, 15 (1993) 147; J. Anxiety Disorders, 9 (1995) 163). Assessment devices such as the Social Interaction Anxiety Scale, the Social Phobia Scale (SIAS and SPS; Behav. Res. Therapy, 36 (4) (1998) 455), and the Anxiety Sensitivity Index (ASI; Behav. Res. Therapy, 24 (1986) 1) are good measures of the presumably separate lower-order factors. This study compared the effectiveness of the SIAS, SPS, ASI-physical scale and STAI-T (State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press (1970)) as predictors of anxious response to a social challenge (asking an aloof confederate out on a date). Consistent with the hierarchical model of anxiety, the measures of trait anxiety were moderately correlated with each other and each was a significant predictor of anxious response. The specific measures of trait social anxiety were slightly better predictors of anxious response to the social challenge than was either the ASI-physical scale or the STAI-T. The results provide evidence of the predictive validity of these social trait measures and some support for their specificity in the prediction of anxious response to a social challenge.     

Psychological health in long-term cancer survivorship: an Italian survey on depression and anxiety

Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their psychological health can inform health care policy as well as help supporting individual patients. This study was aimed to describe depression and anxiety (i.e. two of the most common psychological symptoms reported in oncology) in a sample of Italian long-term cancer survivors (LTCSs) defined as people who have been free from cancer and cancer treatments for at least five years. Four hundred and four Italian adult LTCSs completed a battery of questionnaires including the Zung Self-rating Depression Scale and the State Anxiety sub-scale of the State-Trait Anxiety Inventory respectively for depression and anxiety assessment. 16.5% of the sample displayed mild depression, 11.1% moderate depression, and 7.1% severe depression. depression was negatively associated with education (p = .017), perceived social support as provided by the family (p = .028), and perceived social support provided by friends (p = .008), and it was positively associated with occupational status (p = .023), presence of health issues (p = .010), and anxiety (p < .001). 8.7 and 15.8% of the sample were respectively possible and probable cases of anxiety. Anxiety was negatively associated with occupational status (p = .038) and it was positively associated with depression (p < .001). These data support ongoing assessment and monitoring of depression and anxiety in LTCSs, and stimulate the development and testing of psychological interventions for such individuals. In addition, they encourage further study on the psychological health of this specific population.     

Development of a Short Version of the Dutch Version of the Spielberger STAI Trait Anxiety Scale in Women Suspected of Breast Cancer and Breast Cancer Survivors

The objective of the current study was to develop a short form of the Dutch version of the State-Trait Anxiety Inventory (STAI) Trait scale and to provide initial validation data in a sample of breast cancer patients and survivors. This short trait anxiety (A-Trait) scale was designed to reduce time and effort required of severely ill or handicapped patients involved in extensive assessment procedures. Another goal was to assess A-Trait with minimal overlap with content that reflects Quality of Life (QoL) and fatigue. Three groups of women either completed the original Trait scale (Groups 1 and 2) or the 10-item trait version (Group 3). In Group 1, exploratory factor analysis with the Scree test, Velicer’s MAP criteria and parallel analysis as tests for factor retention, indicated a 10-item Trait version reflecting two factors: Anxiety Present and Anxiety Absent. In the other groups, confirmatory factor analysis showed that the two-factor short form provided the best fit. In all three groups Trait Anxiety was highly related to Neuroticism. The correlation between Overall QoL and General Health and the Anxiety Present short scale was lower than the correlation between Overall QoL and General Health and the full form (Z = 2.20, p = .03). With this short A-Trait scale it becomes possible to study the relationship between dispositional anxiety and clinically important outcome variables without inflating estimates of these relations through psychometric contamination.     

The cortisol awakening response: Associations with trait anxiety and stress reactivity

This study investigated the extent to which trait anxiety and state anxiety in response to stress are associated with the cortisol awakening response (CAR).Fifty-one healthy participants were recruited. State anxiety measures were taken in anticipation of and during a laboratory stressor. Salivary cortisol levels were measured immediately upon awakening (at 0, 15, 30, and 45 min) on two consecutive mornings. Cortisol awakening response was assessed by the area under the curve with respect to zero (AUC_G).The magnitude of the CAR was found to be negatively associated with both trait anxiety and anticipatory anxiety. Moreover, regression analysis showed that the effects of trait anxiety on the AUC_G were mediated by anticipatory anxiety.These results suggest that the CAR is influenced by trait anxiety. Moreover, the effect of trait anxiety on the CAR seems to operate by impacting on psychological stress reactivity (i.e., anticipatory anxiety).     

Trait anxiety, trait depression, worry, and memory

A study is reported which investigated the proposal that high trait anxiety is associated with a memory bias for worry themes. Forty-five participants were categorised as being high or low trait anxious on the basis of scores on the (Spielberger et al., 1983) (Manual for the State-Trait Anxiety Inventory (Form Y) (1983)). The participants were requested to rate a number of worry and non-worry statements for how much they generally thought about the issues represented by them. Analysis of the ratings given by the participants showed that low trait anxiety individuals thought about the non-worry items significantly more than worry items. The high trait anxiety participants, however, showed little or no difference in the amount of time spent thinking about worry and non-worry themes. In a subsequent free recall task of the statements it was observed that the low trait anxiety group recalled significantly more non-worry than worry items, whereas there was no such difference for the high trait group. It was also found that the degree of memory bias was related to both positive affectivity and trait anxiety. The implications of such findings are discussed.     

Reliability and Validity of the Current Anxiety Level Measure

Professionals interested in assessing state anxiety (in the moment) levels before and after brief activity-based treatments would find limited evidence-based assessments. The purpose of this study was to develop and test the current anxiety level measure, a free, valid, and reliable state anxiety assessment. To establish concurrent validity, the current anxiety level measure was administered (n?=?98) alongside the State-Trait Anxiety Inventory. Results found a strong relationship (r?=?.904, p?r?=?.702, p?n?=?102). Both samples showed the current anxiety level measure to be reliable and valid.     

Psychological and autonomic effects of art making in college-aged students

Background and objectives: Anxiety disorders comprise the most common category of mental illness among US young adults. Art making might be one method to help reduce anxiety, but the few studies investigating this have used only subjective measures of anxiety. Design: This study employed both subjective (self-reported state anxiety from the State-Trait Anxiety Inventory) and objective (heart rate variability) measures to assess whether 30-minute periods of art making reduced anxiety in 47 first-year college students prior to their final examinations. Methods: Students participated in free-form painting, mandala coloring, clay modeling, and control sessions. Results: Repeated-measures ANOVA with post hoc analysis revealed significantly greater pre- to post-session reductions in anxiety for all three types of art-making sessions than for the control session, as measured objectively. Measured subjectively, only free-form painting yielded a significant decrease in anxiety compared to the control session. Conclusions: Given the health benefits of anxiety reduction, further study is warranted to determine the duration of art making's anxiety-reducing effect.     

State vs trait anxiety: A case study in confirmatory factor analysis

The State-Trait Anxiety Inventory (STAI; Spielberger et al., 1970) originally divided anxiety into two factors: state anxiety, reflecting how an individual currently feels, and trait anxiety, reflecting how an individual generally feels. Recently, however, Spielberger revised his position to separate the presence and absence of anxiety symptoms within state and trait factors, yielding a hypothetical correlated 4-factor structure (Spielberger et al., 1980). Endler and Magnusson (1965) and Endler et al. (1976) have challenged the state vs trait distinction based upon their own factor analytical results. Since both sets of investigations used exploratory approaches, which do not postulate a particular factor structure, these studies do not provide an explicit test of the state vs trait distinction. A confirmatory factor analytic approach was used in the present study to evaluate Spielberger's 4-factor hypothesis. The subjects were large samples of male air force trainees and high school students for whom STAI data were available. The results of these confirmatory analyses indicated that the factors identified in exploratory analysis by Spielberger and his colleagues accounted for the data quite well.     

Increased skills usage statistically mediates symptom reduction in self-guided internet-delivered cognitive–behavioural therapy for depression and anxiety: a randomised controlled trial

Cognitive–behavioural therapy (CBT) is an effective treatment for clinical and subclinical symptoms of depression and general anxiety, and increases life satisfaction. Patients’ usage of CBT skills is a core aspect of treatment but there is insufficient empirical evidence suggesting that skills usage behaviours are a mechanism of clinical change. This study investigated if an internet-delivered CBT (iCBT) intervention increased the frequency of CBT skills usage behaviours and if this statistically mediated reductions in symptoms and increased life satisfaction. A two-group randomised controlled trial was conducted comparing internet-delivered CBT (n = 65) with a waitlist control group (n = 75). Participants were individuals experiencing clinically significant symptoms of depression or general anxiety. Mixed-linear models analyses revealed that the treatment group reported a significantly higher frequency of skills usage, lower symptoms, and higher life satisfaction by the end of treatment compared with the control group. Results from bootstrapping mediation analyses revealed that the increased skills usage behaviours statistically mediated symptom reductions and increased life satisfaction. Although skills usage and symptom outcomes were assessed concurrently, these findings support the notion that iCBT increases the frequency of skills usage behaviours and suggest that this may be an important mechanism of change.     

The Role of Anger in Generalized Anxiety Disorder

Little is known about the role of anger in the context of anxiety disorders, particularly with generalized anxiety disorder (GAD). The aim of study was to examine the relationship between specific dimensions of anger and GAD. Participants (N = 381) completed a series of questionnaires, including the Generalized Anxiety Disorder Questionnaire (GAD-Q-IV; Newman et al., 2002, Behavior Therapy, 33, 215–233), the State-Trait Anger Expression Inventory (STAXI-2; Spielberger 1999, State-Trait Anger Expression Inventory-2: STAXI-2 professional manual, Odessa, FL: Psychological Assessment Resources) and the Aggression Questionnaire (AQ; Buss & Perry 1992, Journal of Personality and Social Psychology, 63, 452–459). The GAD-Q-IV identifies individuals who meet diagnostic criteria for GAD (i.e. GAD analogues) and those who do not (non-GAD). The STAXI-2 includes subscales for trait anger, externalized anger expression, internalized anger expression, externalized anger control and internalized anger control. The AQ includes subscales for physical aggression, verbal aggression, anger and hostility. The GAD-Q-IV significantly correlated with all STAXI-2 and AQ subscales (r's ranging from .10 to .46). Multivariate analyses of variance revealed that GAD analogues significantly differed from non-GAD participants on the combined STAXI-2 subscales (η² = .098); high levels of trait anger and internalized anger expression contributed the most to GAD group membership. GAD analogue participants also significantly differed from non-GAD participants on the combined AQ subscales (η² = .156); high levels of anger (affective component of aggression) and hostility contributed the most to GAD group membership. Within the GAD analogue group, the STAXI-2 and AQ subscales significantly predicted GAD symptom severity (R ² = .124 and .198, respectively). Elevated levels of multiple dimensions of anger characterize individuals who meet diagnostic criteria for GAD.     

The frequency of actions and thoughts scale: development and psychometric validation of a measure of adaptive behaviours and cognitions

This paper describes the development and preliminary psychometric evaluation of an instrument that measures the frequency of adaptive behaviours and cognitions related to therapeutic change during cognitive behavioural therapy (CBT), for symptoms of anxiety and depression. Two studies were conducted. In study one, 661 participants completed an online survey with 28 items targeting adaptive behaviours and cognitions. Exploratory factor analysis performed on part of the sample (n = 451) revealed that a four-factor solution ‘characterised’ the data. This led to the development of a 12-item instrument, the Frequency of Actions and Thoughts Scale (FATS). Confirmatory factor analysis was used to confirm the factor structure of the FATS using the remaining sample (n = 210), which revealed an acceptable model fit. In study two, 125 participants with clinically significant symptoms of anxiety, depression, or both were recruited to an Internet-delivered CBT (iCBT) treatment course. Participants completed the FATS and other measures throughout treatment, after treatment, and at three-month follow-up. Correlations and residual change scores of the FATS and its subscales with measures of anxiety, depression, behavioural activation, and CBT-related skills usage supported the construct validity of the FATS. A significant increase in FATS scores over treatment was also observed. The findings provide preliminary support for the psychometric properties of the FATS, which appears to have utility in research investigating mechanisms of change in CBT.     

The Portuguese Version of the Psychological Adjustment to Separation Test-Part A (PAST-A): A Study with Recently and Non-recently Divorced Adults

Past research has demonstrated that divorced adults show more health problems and psychological distress than married adults. Considering the high prevalence rates of divorce among Western countries, new and robust measures should be developed to measure psychological distress after this specific transition in adulthood. The aim of this study was to adapt and validate a Portuguese version of the Psychological Adjustment to Separation Test-Part A (PAST-A; Sweeper and Halford in J Family Psychol 20(4):632–640, 2006). PAST-A is a self-report measure that assesses two key dimensions of separation adjustment problems: lonely-negativity and former partner attachment. Psychometric properties of the Portuguese version of PAST-A were assessed in terms of factor structure, internal consistency, and convergent and divergent validity, in an online convenience sample with divorced adults (N = 460). The PAST-A two-factor structure was confirmed by exploratory and confirmatory factor analyses, with each factor demonstrating very satisfactory internal consistency and good convergence. In terms of discriminant validity, the Portuguese PAST-A reveals a distinct factor from psychological growth after divorce. The results provided support for the use of the Portuguese PAST-A with divorced adults and also suggested that the explicative factors of the psychological adjustment to divorce may be cross-cultural stable. The non-existence of validated divorce-related well-being measures and its implications for divorce research are also discussed.     

Self-reports of depression and state-trait anxiety: evidence for differential assessment.

Several researchers have found anxiety and depression to be indistinguishable in nonclinical samples and have suggested that both constructs may be components of a general psychological distress process. Another possibility is that overlap is due to the psychometric limitations of scales used. A series of exploratory factor analyses were conducted in a nonclinical sample (N = 605) using the Beck Depression Inventory (BDI; Beck, 1978), the State-Trait Anxiety Inventory (STAI; Spielberger, 1983), and the Endler Multidimensional Anxiety Scales (EMAS; Endler, Edwards, & Vitelli, 1991). Both state and trait anxiety and depression could be differentiated with the BDI and the EMAS but not with the STAI. Some theoretical models of negative affectivity or general psychopathology may be premature.     

A Randomized Trial of Mindfulness-Based Cognitive Therapy for Children: Promoting Mindful Attention to Enhance Social-Emotional Resiliency in Children

Mindfulness-based cognitive therapy for children (MBCT-C) is a manualized group psychotherapy for children ages 9–13 years old, which was developed specifically to increase social-emotional resiliency through the enhancement of mindful attention. Program development is described along with results of the initial randomized controlled trial. We tested the hypotheses that children randomized to participate in MBCT-C would show greater reductions in (a) attention problems, (b) anxiety symptoms, and (c) behavior problems than wait-listed age and gender-matched controls. Participants were boys and girls aged 9–13 (N = 25), mostly from low-income, inner-city households. Twenty-one of 25 children were ethnic minorities. A randomized cross-lagged design provided a wait-listed control group, a second trial of MBCT-C, and a 3-month follow-up of children who completed the first trial. Measures included the Child Behavior Checklist, State-Trait Anxiety Inventory for Children, and Multidimensional Anxiety Scale for Children. Participants who completed the program showed fewer attention problems than wait-listed controls and those improvements were maintained at three months following the intervention [F (1, 1, 18) = 5.965, p = .025, Cohen’s d = .42]. A strong relationship was found between attention problems and behavior problems (r = .678, p < .01). Reductions in attention problems accounted for 46% of the variance of changes in behavior problems, although attention changes proved to be a non-significant mediator of behavior problems (p = .053). Significant reductions in anxiety symptoms and behavior problems were found for those children who reported clinically elevated levels of anxiety at pretest (n = 6). Results show that MBCT-C is a promising intervention for attention and behavior problems, and may reduce childhood anxiety symptoms.     

ANXIETY SENSITIVITY AND TRAIT-SYMPTOM MEASURES OF ANXIETY AND DEPRESSION

The Icelandic version of the Anxiety Sensitivity Index was investigated in two studies of college students. A principal components analysis of ASI scores from both studies (N=718) yielded three components similar to what has been found previously: Psychological Concerns, Physical Concerns and Social Concerns. In the first study the relationship between the ASI and trait anxiety was investigated. It was analysed at the level of the total scales but also at the level of subscales of both instruments. Two subscales of the STAI, measuring respectively Anxiety-trait and Depression-trait, were used as well as the Psychological Concerns and Physical Concerns subscales of the ASI. In a second study the relationships between ASI and its subscales and two symptom measures of anxiety and depression were addressed. ASI was in both studies more strongly related to the anxiety than the depression scales. Also, in both studies the Physical Concerns subscale of the ASI was more strongly related to anxiety than to depression, whereas the Psychological Concerns subscale was equally related to anxiety and depression. Taken together the studies support the notion of different relationships between different aspects of anxiety sensitivity, and anxiety and depression as traits, cognitive symptoms and mood related symptoms.     

The relationship of academic major and career choice status to anxiety among college freshmen

This study examines the relationship of career and academic major choice status to levels of state anxiety among undergraduate students. A total of 179 resident freshmen responded to a questionnaire concerning their career development status. On the basis of that information, subjects were arranged within a 2 × 2 factorial design of two dichotomous variables: career choice status (decided/undecided) and major choice status (declared/undeclared). Participants were administered the State-Trait Anxiety Inventory. An analysis of variance of state anxiety scores yielded a significant main effect for career choice status, with subjects reporting they had already decided on a career direction exhibiting lower levels of state anxiety than those who had not.     

Rorschach correlates of state and trait anxiety in college students

This study was done to determine whether Elizur's anxiety scoring (AL) for Rorschach content was correlated to scores on Spielberger's State-Trait Anxiety Inventory (STAI). The definition of anxiety presented by Elizur implies that his technique measures anxiety as a long-term, relatively stable personality characteristic rather than a transitory emotional state, but no research has shown whether AL was correlated with state and/or trait anxiety as defined and measured by Spielberger. The State-Trait Anxiety Inventory was administered in small groups to 40 college students with a repeated measure of STAI State-anxiety and the Rorschach given individually following a delay of at least five days. Analysis indicated that the STAI Trait-anxiety measure correlated significantly with AL. Test-retest correlations for STAI State-anxiety measures and STAI State- and Trait-anxiety measures obtained in the same testing session were significant. State-anxiety scores obtained just prior to Rorschach testing were related to STAI Trait-anxiety scores and initial STAI State-anxiety scores correlated with AL.