Acceptance of Tinnitus: Validation of the Tinnitus Acceptance Questionnaire

Internet‐based interventions with therapist support have proven effective for treating a range of mental health conditions. This study examined whether frequency of therapist contact affected treatment outcomes. Fifty‐seven people with panic disorder (including 32 with agoraphobia) were randomly allocated to an 8‐week Internet‐based cognitive behavioural treatment intervention (Panic Online) with either frequent (three e‐mails per week) or infrequent (one e‐mail per week) support from a psychologist. Posttreatment, intention‐to‐treat analyses revealed that both treatments were effective at improving panic disorder and agoraphobia severity ratings, panic‐related cognitions, negative affect, and psychological and physical quality of life domains, with no differences between conditions. High end‐state functioning was achieved by 28.6% of the frequent and infrequent participants, respectively. Therapist alliance, treatment credibility, and satisfaction also did not differ between groups, despite significantly greater therapist time invested in the frequent contact condition. The results provide evidence that the effectiveness of Internet‐based mental health interventions may be independent of the frequency of therapist support and may, therefore, be more cost‐effective than previously reported.     

Influence of Co‐Morbid Generalized Anxiety Disorder,Panic Disorder and Personality Disorders on the Outcome of Cognitive Behavioural Treatment of Obsessive‐Compulsive Disorder

This study examined co‐morbid generalized anxiety disorder and/or panic disorder and personality disorders as predictors of treatment outcomes in adult outpatients with obsessive‐compulsive disorder. The patients received exposure with response prevention (ERP) treatment with the addition of either elements of cognitive therapy (ERP+CT) or relaxation training (ERP+REL). It was hypothesized that the addition of cognitive interventions would yield better treatment outcomes for patients with co‐morbid generalized anxiety disorder and/or panic disorder. It was also hypothesized that patients with any personality disorder would show less treatment gains in both conditions. Using intention‐to‐treat criteria, patients with generalized anxiety disorder and/or panic disorder co‐morbidity showed less treatment gains at post‐treatment across both treatment conditions. This group showed significantly more treatment gains in the ERP+CT condition at the post‐treatment and the 12‐month follow‐up assessments compared with patients in the ERP+REL condition. However, this was not significant when comparing treatment completers. Patients with a co‐morbid Cluster A or B personality disorder showed significantly less treatment gains in both treatment conditions at the 12‐month follow‐up assessment. Among treatment completers, patients with a Cluster C personality disorder showed significantly better outcomes at the post‐treatment assessment in the ERP+REL treatment condition. These results, clinical implications, and the importance of further investigations are discussed.     

Psychological sequelae of remote exposure to the September 11th terrorist attacks in Canadians with and without panic

The purpose of the present investigation was to examine the psychological impact of remote exposure to the events and aftermath of the terrorist attacks in the USA on September 11th, 2001, and to assess what differences, if any, exist between individuals classified with probable panic disorder and those without. Telephone interviews were conducted with 122 residents of the capital city of the Canadian prairie province of Saskatchewan in spring 2002 in order to gather information regarding current mood, fears and avoidance behaviours as well as current post‐traumatic stress disorder symptoms specific to September 11th. Consistent with previous findings and despite the remote nature of exposure, results indicated that the psychological well‐being and behaviour of participants with probable panic disorder was more adversely affected by the events and aftermath of September 11th than those without panic disorder. These results suggest that remote viewing of traumatic events can have a significant and lingering impact on psychological well‐being and behaviour and that these effects are more pronounced in those with panic disorder. Implications of the findings and future research directions are discussed.     

Children's self‐reports and parents' reports of internalising and externalising problems in Chinese and Anglo‐Celtic children in Australia

The Child Behaviour Checklist (CBCL) and Youth Self‐Report (YSR) are widely used measures of internalising and externalising problems in children and adolescents, but cross‐cultural differences in these problems have not been examined in Australian children of Chinese and Anglo‐Celtic ancestry. Fifty‐nine Chinese (27 boys and 32 girls) and 65 Anglo‐Celtic Australian (35 boys and 30 girls) children aged 10–13 years completed the YSR, and one of their parents completed the CBCL. Cross‐informant agreement between these two measures was also examined. No differences were found between the Chinese and Anglo‐Celtic groups on parents' and children's ratings on any syndrome or overall scales. The overall level of agreement between YSR and CBCL scores was poor in the Anglo‐Celtic group (intraclass correlation coefficient for total problems = 0.33), but there was no agreement between these scores in the Chinese group. Results highlight the need to obtain multiple sources of information in assessments of mental health problems in children from different cultural backgrounds.     

Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome

Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) were not associated with differential improvement on a measure of panic disorder severity, although only rates of comorbid GAD were significantly lower at posttreatment. Treatment responders showed greater reductions on measures of anxiety and depressive symptoms. These data suggest that comorbid anxiety and depression are not an impediment to treatment response, and successful treatment of panic disorder is associated with reductions of comorbid anxiety and depressive symptoms. Implications for treatment specificity and conceptual understandings of comorbidity are discussed.     

The many faces of Pan: psychological and physiological differences among three types of panic attacks.

The thesis of this paper is that failure to recognize the psychological and physiological differences among panic attacks within DSM-IIIR precludes meaningful comparisons and evaluations of research findings, confounds theoretical issues, and impairs the development of more specific, and thereby more effective, programs of treatment. To remedy this, a recommendation is made to define panic attacks on the basis of psychological and physiological distinctions that fit three categories of severity: Type I (classic panic attack), Type II (anticipatory panic attack), and Type III (cognitive panic attack). The logical-empirical rationale for the categories recommended is presented in the context of relevant research findings. Implications for theory, experimental design, and treatment are discussed.     

The Role of Culture,Workgroup Membership,and Organizational Status on Cooperation and Trust: An Experimental Investigation

We examined how interactions among participants' cultural backgrounds (e.g., Australian vs. Singaporean) and multiple subgroups (e.g., cultural group membership, workgroup membership, organizational status) affect trust and cooperation in the workplace. University students (120 Australians, 120 Singaporeans) responded to hypothetical scenarios of cooperation and trust in the workplace. The results indicated that, for both Australians and Singaporeans, trust and cooperation were more strongly influenced by workgroup membership and organizational status than by cultural group membership. Participants trusted and cooperated more with work in‐group members than with work out‐group members, and trusted and cooperated more with superiors than with peers. Theoretical implications are discussed.     

Book Reviews

Panic attacks and depression frequently co‐occur, and the presence of this co‐morbidity is often associated with worse outcomes compared with each disorder alone. Despite this, not everyone who experiences panic attacks also suffers from depression, suggesting that individual difference factors may play a role in this co‐morbidity. The purpose of this study was to provide a preliminary investigation of two such individual difference factors, examining the role of anxiety sensitivity and lack of emotional approach coping in depressive symptom severity among a non‐clinical sample of uncued panickers. A sample of 79 college students reporting the occurrence of uncued panic attacks within the past year completed a series of questionnaires assessing the lower‐order factors of anxiety sensitivity, emotional approach coping, panic attack frequency, panic‐related disability, panic symptom severity and depressive symptom severity. Participants with more severe depressive symptoms reported greater anxiety sensitivity, panic attack frequency, panic symptom severity, panic‐related disability and lack of emotional approach coping. The particular anxiety sensitivity dimension of fear of cognitive dyscontrol and lack of emotional approach coping emerged as the best predictors of depressive symptom severity. Findings are discussed in terms of their implications for the improved understanding of this co‐morbidity, as well as its treatment.     

Cultural differences in attitude toward and effects of self‐doubt

It has been argued that the high achievement of Confucian Asian students is at the cost of their psychological well‐being, since high self‐doubt consistently accompanies their high achievement. However, other researchers cautioned that the attitude toward self‐doubt could be different in Asian versus Western cultures. This study examined the debate with a survey of both American and Chinese college students that measured level of self‐doubt, attitude toward self‐doubt, beliefs about ability, and psychological well‐being outcomes. As hypothesized, Chinese students showed a more positive attitude toward self‐doubt than American students, despite having higher level of self‐doubt. Furthermore, self‐doubt engendered less negative consequences on Chinese students' psychological well‐being, relative to American students. Implications for theories and research on cultural differences in the effects of self‐constructs are discussed.     

GENDER DIVISION OF TASKS BY PARENTS AND THEIR CHILDREN

The division of parenting tasks between wives and husbands was explored in a sample of 279 Australian families containing a 9–1 1-year-old child, and the children's performance of household tasks was compared with their parents' division of labor. Three parenting factors (domestic care, leisure/enrichment, and psychological), and four child factors (handyman, domestic, maturity, and babysitting) were obtained. Mothers were more active than fathers on all three parenting factors, but significant differences were found between parents of differing SES and cultural backgrounds. Among children, the greatest sex difference was found on the handyman factor, where boys greatly outperformed girls. Boys' performance on this factor was not related to parental division of labor or social background, but girls' performance was higher when they were only children and when they lived in higher SES families. Girls outperformed boys on the domestic and maturity factors. Parenting style, SES, and cultural background also were significantly related to these factor scores. Apart from child's sex, cultural background was the strongest predictor of children's task performance.     

An Investigation of Psychology Staffing in Australian Metropolitan Acute Public Hospitals

Psychology is one component of the multidisciplinary services provided to patients in acute public hospitals, with research demonstrating that psychological intervention significantly enhances clinical outcomes for patients across a range of health issues. Despite the increasingly important role that psychologists play in Australian hospitals, there remains a lack of information available about staff levels, discipline structures, and clinical activity for psychological services within acute hospital settings. The most recent Australian data about hospital‐based psychology services was collected 20 years ago. The current study provides updated information from a survey of 15 Australian metropolitan, acute public hospitals: presenting and critically reviewing staffing configurations and models of service delivery. Results suggest that: (a) hospitals employ a highly skilled workforce at a rate of 0.16 full‐time equivalent psychology staff for every 10 hospital beds; (b) psychologists have a viable career pathway within the hospital‐based health sector; (c) role diversity is common, with the primary focus varying as a function of position level; (d) neuropsychology staffing requires urgent attention to address significant delays in access to services; and (e) public hospitals actively contribute to current and future workforce development through supervision, research, and training. The implications of these results for the future of psychological services in Australian healthcare are discussed.     

The adaptation of Chinese adolescents in two societies: a comparison of Chinese adolescents in Hong Kong and Australia

This study aimed to compare the adaptation of two groups of migrant Chinese adolescents with their nonmigrant peers. The migrant adolescents included 55 Chinese migrant adolescents who migrated to Australia (Chinese‐Australian) and 111 China‐born adolescents who migrated to Hong Kong (Chinese‐Hong Kong). The nonmigrant adolescents included 157 Anglo‐Australian adolescents residing in Australia and 456 Hong Kong‐born Chinese adolescents residing in Hong Kong. There were three research questions in this study. First, would there be any differences in the adaptation of Chinese migrant adolescents in different societies of settlement? Second, would migrant adolescents experience more adaptation problems than nonmigrant adolescents? Third, would there be any differences in the adaptation of adolescents in the two societies, Australia and Hong Kong? It was hypothesized that: (1) mainland Chinese migrant adolescents in Hong Kong would experience more adaptation problems than Chinese migrant adolescents in Australia; (2) migrant adolescents would report better adaptation than nonmigrant adolescents; (3) adolescents in Hong Kong would report poorer adaptation than adolescents in Australia. The participants were requested to complete a questionnaire on various adaptation outcome measures including life satisfaction, self‐esteem, psychological symptoms, academic satisfaction, and behaviour problems. The results indicated that Chinese‐Australian adolescents reported better psychological adaptation but Chinese‐Hong Kong adolescents reported better sociocultural adaptation. Adolescents resident in Australia reported higher psychological adaptation but lower sociocultural adaptation than those in Hong Kong. Migrant adolescents reported better psychological and sociocultural adaptation than their nonmigrant counterparts. The results were discussed in relation to the social and educational systems of the two societies.     

Influence of co-morbid generalized anxiety disorder, panic disorder and personality disorders on the outcome of cognitive behavioural treatment of obsessive-compulsive disorder

This study examined co-morbid generalized anxiety disorder and/or panic disorder and personality disorders as predictors of treatment outcomes in adult outpatients with obsessive-compulsive disorder. The patients received exposure with response prevention (ERP) treatment with the addition of either elements of cognitive therapy (ERP+CT) or relaxation training (ERP+REL). It was hypothesized that the addition of cognitive interventions would yield better treatment outcomes for patients with co-morbid generalized anxiety disorder and/or panic disorder. It was also hypothesized that patients with any personality disorder would show less treatment gains in both conditions. Using intention-to-treat criteria, patients with generalized anxiety disorder and/or panic disorder co-morbidity showed less treatment gains at post-treatment across both treatment conditions. This group showed significantly more treatment gains in the ERP+CT condition at the post-treatment and the 12-month follow-up assessments compared with patients in the ERP+REL condition. However, this was not significant when comparing treatment completers. Patients with a co-morbid Cluster A or B personality disorder showed significantly less treatment gains in both treatment conditions at the 12-month follow-up assessment. Among treatment completers, patients with a Cluster C personality disorder showed significantly better outcomes at the post-treatment assessment in the ERP+REL treatment condition. These results, clinical implications, and the importance of further investigations are discussed.     

Agoraphobic avoidance and panic frequency as predictors of laboratory induced panic reactions

This study examined the importance of agoraphobic avoidance and frequency of panic as predictors of psychological and physiological responses of panic sufferers to a laboratory based provocation procedure. Psychophysiologic comparisons were made between 22 panic disorder patients and 15 controls, at baseline and across three periods of carbon dioxide gas inhalations (1, 3, 5%; balance oxygen). Subjective measures of anxiety, frightening cognitions and body sensations were obtained across the phases. Physiological measures of minute ventilation, breathing rate, tidal volume, end tidal CO₂ and heart rate were also obtained. Between group comparisons revealed significant differences between the groups on the subjective measures with no significant differences occurring on the physiological measures. Within group analyses revealed that pre-session questionnaire measures of agoraphobia avoidance and panic frequency predicted the degree of anxiety, frightening sensations and cognitions during baseline and 5% CO₂ inhalation. The results indicated that both self-reported agoraphobic avoidance and panic frequency are strong clinical predictors of psychological reactions of panic sufferers during laboratory provocation.     

Treatment of Panic Disorder with Agoraphobia: Randomized Placebo‐Controlled Trial of Four Psychosocial Treatments Combined with Imipramine or Placebo

Few randomized controlled trials have included panic disorder patients with moderate to severe agoraphobia. Therefore, this population was studied using pharmacotherapy as well as psychotherapy. At the time of the study, imipramine was widely used as a pharmacological treatment. Also, current practice guidelines for patients with panic disorder find selective serotonin reuptake inhibitors and tricyclic antidepressants roughly comparable in terms of efficacy. Therefore, the main objective of this study is to compare four psychosocial treatments—cognitive and graded in vivo exposure treatments, graded in vivo exposure, cognitive treatment, and supportive therapy—to evaluate the benefits of combining cognitive therapy with exposure in vivo. These treatments were combined with imipramine or placebo for a total of eight experimental conditions. Participants presented moderate to severe agoraphobia. The method involved a randomized, double‐blind, placebo‐controlled trial with 137 participants who completed a 14‐session protocol involving the treatments just mentioned. Measures were taken at baseline and posttreatment and at 3‐, 6‐, and 12‐month follow‐up. All treatment conditions were statistically and clinically effective in reducing self‐reported panic–agoraphobia symptoms over the 1‐year follow‐up. No statistical differences were observed between imipramine and placebo conditions. This study found that all treatment modalities helped reduce panic and agoraphobic symptomatology over a 1‐year follow‐up period. These surprising results support the need to document the relations among the various components of an intervention. This would make it possible to assess the relative efficacy of the treatment components rather than of the intervention as a whole.     

The Effectiveness of the Within Our Reach Relationship Education Program for Couples: Findings from a Federal Randomized Trial

This study examined the effectiveness of a couple‐based relationship education program, Within Our Reach. Secondary data (n = 3,609) were analyzed from the federal Supporting Healthy Marriage project. Couples were randomly assigned to receive Within Our Reach and associated services or to a no‐treatment (treatment‐as‐usual) control group. Those assigned to Within Our Reach reported better couple and individual outcomes on 8 of 12 outcomes measured (M ES = .15) at the 12‐month follow‐up and 6 of 10 outcomes measured at the 30‐month follow‐up (M ES = .14), including higher relationship happiness, more warmth and support, more positive communication, less negative behavior and emotion, less psychological abuse, less physical assault (for men), lower psychological distress (for women), and less infidelity. They were also less likely to report that their marriage was in trouble. These effects were generally small in size and many were replicated across the two follow‐ups. There were no significant differences between those assigned to Within Our Reach versus control on cooperative parenting, severe psychological assault, or percent married. Implications for future research, programming, and policy are discussed.     

Cognitive behavioral therapy for panic disorder and comorbidity: more of the same or less of more?

This study compared the effects of a higher dose of cognitive behavioral therapy (CBT) for panic disorder versus CBT for panic disorder combined with "straying" to CBT for comorbid disorders in individuals with a principal diagnosis of panic disorder with or without agoraphobia. Sixty-five participants were randomly assigned to one of two treatment conditions, either CBT focused solely upon panic disorder and agoraphobia or CBT that simultaneously addressed panic disorder and agoraphobia and, to a lesser degree, the most severe comorbid condition. Results indicated a significant reduction in panic disorder severity and a decline in severity of comorbid diagnoses across both treatment conditions. However, individuals receiving CBT focused only on panic disorder were more likely to meet high end-state functioning at post-treatment, even in intent-to-treat analyses, and report zero panic attacks at the 1-year follow-up, although this effect was not retained in intent-to-treat analyses. At follow-up, CBT focused only on panic disorder yielded more substantial improvement in the most severe baseline comorbid condition, although not in intent-to-treat analyses, and a greater proportion of individuals in this treatment condition were rated as having no comorbid diagnoses, even in intent-to-treat analyses. These findings raise the possibility that remaining focused on CBT for panic disorder may be more beneficial for both principal and comorbid diagnoses than combining CBT for panic disorder with 'straying' to CBT for comorbid disorders.     

Parenting and temperament as predictors of prosocial behaviour in Australian and Turkish Australian children

This study investigated the direct and indirect roles of parenting, child temperament and sociocultural context in predicting prosocial behaviour as identified by behavioural assessments and parent and teacher ratings. Comparisons of Australian children and Turkish children living in Australia allowed examination of cultural similarities and differences in levels of prosocial behaviours and in their predictors. Participants were 153 Australian 4–6‐year‐old children and 58 children with a Turkish background recruited from childcare centres serving low‐ and middle‐class communities. Turkish and Australian children were similar in their levels of prosocial development, but the factors that predicted prosocial behaviour were somewhat different. Hierarchical multiple regression showed that maternal warmth and child persistence predicted prosocial behaviour for the Australian sample. For the Turkish sample, obedience‐demanding behaviour had a facilitating effect upon prosocial development. The results are discussed in relation to cultural norms and their impact on children through parenting practices.     

Physiological and psychological reactivity in women with asthma: the effects of anxiety and menstrual cycle phase.

The relation between menstrual cycle timing, panic attacks, and diagnosis of asthma was explored in this study. Women with or without asthma and with or without a history of panic attacks engaged in a psychophysiological task during either the intermenstrual or premenstrual cycle phase and completed self-report measures of menstrual symptoms and attitudes, general psychological symptoms, and attitudes toward illness. No significant differences were identified for psychological or psychophysiological measures with menstrual cycle phase as a factor. However, women with both asthma and a history of panic attacks reported more general psychological distress than women in the other groups, and more state anxiety than controls. Women in the asthma, asthma and panic, and panic groups reported higher anxiety sensitivity than the control group. After listening to asthma-related scenes, women with asthma exhibited a decrease in peak expiratory air flow, and women with asthma and panic exhibited increased skin conductance response magnitude. Implications for the role of anxiety in lung function are discussed, as well as directions for future research with asthma and anxiety populations.     

Is Belief in God Related to Differences in Adolescents’ Psychological Functioning?

Many studies have documented links between positive psychological functioning and religiousness during the adolescent years, but very few have contrasted religious and nonreligious youth. The purpose of the present study was to examine differences in psychological functioning among adolescent atheists, agnostics, and believers using a profile analysis approach. The authors conducted a survey of Grade 8 students (N = 1,925) enrolled in Catholic schools in two Australian states. The survey included 10 measures of psychological functioning, broadly divided into three categories (positive adjustment, social well‐being, and negative outcomes). Results indicated that belief in God was related to distinct profiles of psychological adjustment. The implications of these findings for understanding how differing value systems are related to particular developmental stages are discussed.