Structure of the Computer-Assisted Beck Anxiety Inventory With Psychiatric Inpatients

To determine the dimensions of self-reported anxiety in psychiatric inpatients, the Beck Anxiety Inventory (BAI; Beck & Steer, 1990) was administered by computer to 250 inpatients diagnosed with mixed disorders. An iterated principal-factor analysis was performed on the intercorrelations among the 21 BAI items using a Promax rotation. Two factors were found representing somatic and subjective symptoms of anxiety. These dimensions significantly matched those previously described by Beck, Epstein, Brown, and Steer (1988) for outpatients diagnosed with mixed psychiatric disorders. The generalizability of the somatic and subjective dimensions for inpatients and outpatients is discussed.     

The discrepant repressor: differentiation between low anxiety, high anxiety, and repression of anxiety by autonomic-facial-verbal patterns of behavior

This study examined the notion that personality questionnaires can be used to predict different styles of coping with anxiety as expressed by individual differences in patterns of autonomic, verbal, and nonverbal reactions. In line with earlier modifications of the repression-sensitization concept, the Taylor Manifest Anxiety Scale (MAS) and the Marlowe-Crowne Social Desirability Scale (SDS) were used to select four groups of 12 subjects each from a pool of 206 male students in Germany: low-anxious subjects (low MAS, low SDS), repressors (low MAS, high SDS), high-anxious subjects (high MAS, low SDS), and defensive high-anxious subjects (high MAS, high SDS). Several measures of autonomic arousal, facial activity, and self-reported affect were obtained during a potentially anxiety-arousing free-association task and during a number of control conditions, including a funny film. Significant differences in baseline-corrected heart rate and self-reported anxiety as well as rated facial anxiety all indicated that repressors exhibited a discrepancy between low self-reported anxiety and high heart rate and facial anxiety; low-anxious subjects reported an intermediate level of anxiety, although they showed low heart rate and facial anxiety; high-anxious subjects had consistently high values on all three variables; and the defensive high-anxious group showed an intermediate level of anxious responding. These group differences were specific to the task of freely associating to phrases of mixed (sexual, aggressive, neutral) content (but not to other experimental situations) and to self-reported anxiety (but not to other self-rated emotions or task difficult), indicating that they reflect individual differences in coping with anxiety.     

The relationship among guilt, dysphoria, anxiety and obsessions in a normal population--an attempted replication

The results of a previous study indicated that guilt as rated on the Perceived Guilt Index (PGI), predicted unpleasant intrusive thoughts, but self-reported anxiety and depression did not. In the present investigation, subjects indicated whether or not they experienced both pleasant and unpleasant intrusive thoughts, their frequency and a rating of how pleasant or unpleasant these thoughts were. They also completed self report ratings of depression, anxiety, obsessional ritualizing, and the PGI. Results of a regression analysis indicate that the best standardised questionnaire predictor of unpleasant intrusive thoughts is depression as rated on the BDI, and anxiety as rated on the BAI. The best standardised questionnaire predictor of pleasant intrusive thoughts is low anxiety. The PGI does not independently predict pleasant or unpleasant intrusive thoughts.     

Physiological hyperarousal: construct validity of a central aspect of the tripartite model of depression and anxiety.

Physiological hyperarousal (PH) is an understudied component of the tripartite model of depression and anxiety. This study contributes to the literature on PH, the tripartite model, and anxiety and its disorders, using data from psychotherapy outpatients (n = 2,448), air force cadets (n = 1,335), and undergraduates (n = 284). Psychometrics and exploratory and confirmatory factor analyses showed that PH is a reliable, cohesive, discriminable, and valid construct. Compared with subjective anxiety, PH was more associated to panic versus mood disordered status, and to panic versus generalized anxiety disordered status. As hypothesized, an aspect of anxiety sensitivity (i.e., fear of body sensations) was particularly related to subjective anxiety in the presence of PH. Results support the PH construct as replicable, valid, and clinically important and support the utility of the tripartite and related models for understanding the relation of depressive and anxious syndromes.     

Test anxiety and ego-threatening stress: Over- (and under-) estimation of emotional reactivity

Abstract

This study examined discrepancies between subjective and objective measures of state anxiety as a function of test anxiety in undergraduates. Under evaluative stress conditions, state anxiety was assessed in terms of (a) self-reported cognitive and somatic anxiety, (b) behavioral reactivity (motor and facial tension, avoidance comments and avoidance of eye contact), (c) physiological arousal (heart rate and skin resistance), and (d) cognitive and motor task performance. Participants high in test anxiety showed disproportionately greater self-reported than objective state anxiety. In contrast, those low in test anxiety showed lower self-reported than objective anxiety. The high- and the low-test-anxiety groups differed only in self-reported emotional reactivity. In line with current cognitive theories of anxiety, overestimation of reactivity in high-test anxiety, as well as underestimation in low-test anxiety, are conceptualized as a hypervigilance bias and an avoidance bias, respectively, in processing internal cues, i.e., prioritization and inhibition of attention to one's own behavioral and physiological signs of distress.     

Responses to false physiological feedback in individuals with panic attacks and elevated anxiety sensitivity

Participants with elevated anxiety sensitivity and a history of panic attacks were compared to a low anxiety comparison group with respect to physiological and subjective reactivity to false heart-rate feedback and reactivity to a priming procedure. Whereas accurate heart-rate feedback elicited minimal responses, participants across groups showed significant physiological and subjective responses to false feedback. High risk and low risk participants did not differ in heart-rate responses to false feedback, though panic attack frequency did predict physiological and subjective reactions to false feedback in the high risk group. Self-reported nonspecific anxiety was significantly higher in high risk female participants than in low risk female participants, while males did not different in general subjective anxiety. However, high risk participants reported more panic-specific symptoms during the false feedback task than low risk participants, regardless of the sex of the participant. Therefore, although the experimental paradigm appeared to trigger nonspecific anxiety in high risk female participants, panic attack symptoms in reaction to the task were specific to risk group, not sex, and consistent with hypotheses. Surprisingly, the priming procedure did not influence physiological or subjective responses to false feedback in either group. These results raise additional questions regarding the process and impact of interoception in individuals with panic attacks, and suggest that false perception of internal changes may contribute to risk for panic disorder when exposed to believable cues.     

Which Symptoms of Depression and Anxiety Matter Most? An Investigation of Subjective Importance Ratings With College Students in India

One goal of clinical psychological science is to help people with problems that matter to them. However, little is known about which kinds of symptoms are viewed as most important, particularly among individuals in non-western settings. We examined the extent to which young adults in India rated individual symptoms of depression and anxiety as important, concerning, and undesirable. Participants were college students at Indian Universities (n = 283). They received a measure of depressive symptoms (Patient Health Questionnaire-9) and anxiety symptoms (Generalized Anxiety Disorder Screener-7). For each of the 16 symptoms, they provided three judgments relating to the extent to which they found the symptom important, harmful, and undesirable. These judgments were averaged to form a “subjective importance rating” (SIR) for each symptom. Anxiety symptoms were viewed as more important than depressive symptoms (d = 0.34), and nonsomatic symptoms were viewed as more important than somatic symptoms (d = 0.83). Females rated symptoms as more important than males (d = 0.32), and individuals with higher self-reported symptoms rated symptoms as more important. Sad mood, suicidal ideation, and controlling worries were rated as the most important symptoms, whereas concentration problems, appetite problems, and psychomotor problems were rated as the least important. Overall, some symptoms are viewed as more important and concerning than others. We discuss how this understanding can affect our conceptualization, assessment, and treatment of mental disorders around the world.     

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.     

Comorbidity of test anxiety and other anxiety disorders in children

Elementary school children with clinically significant test anxiety, as determined by self-report and a clinical interview, were assessed for the incidence of other fears and anxiety. The results indicated that test-anxious children reported more fears and general worries than their non-test-anxious peers. As expected, the test-anxious children experienced more negative cognitions and subjective distress when taking a test. Furthermore, the fear of negative evaluation was not limited to an actual test, since these children also reported identical symptoms when engaged in a second social-evaluative task. Finally, 60% of the testanxious sample met DSM-III criteria for an anxiety disorder. The results are discussed in terms of the relationship of text anxiety to more complex social-evaluative dysfunctions, more pervasive anxiety conditions, DSM-III anxiety disorders, and the utility of test anxiety as an indicator of the presence of these more pervasive anxiety states.This research is based on a dissertation conducted by the first author under the direction of the second author. Thanks are expressed to Stephen B. Manuck, Scott M. Monroe, Sharon Nelson-LeGall, and Saul Shiffman, who served as committee members. This study was supported in part by National Institute of Mental Health Grants No. 30915 and No. 16804, and a grant to the first author from the Sigma Xi Foundation.     

Physical illness and symptoms of depression among elderly outpatients.

Elderly outpatients were assessed to clarify relations between symptoms of depression and physical illness, disability, pain, and selected psychosocial variables. Three types of assessments were made: (a) medical evaluations by physicians, (b) self-reported symptoms of depression and physical health, and (c) demographic and psychosocial data relating to participants' life circumstances. Both objective (physician-rated illness symptoms) and subjective (self-reported health, activity restriction, and use of pain medications) indicators of health accounted for independent variance in symptoms of depression. After controlling for these factors, additional variance was explained by health-related concerns (e.g., health care expenses, service needs), social support, and "other worries" (e.g., feeling useless, becoming a burden to others).     

The impact of anxiety on sexual arousal in women

This study examined the impact of state anxiety, trait anxiety, and anxiety sensitivity on physiological and self-report measures of sexual arousal and sexual function in a non-clinical sample of women. Physiological sexual responses to an erotic stimulus were assessed using vaginal photoplethysmography, and subjective reactions were measured using questionnaires. Results suggested a curvilinear relationship between state anxiety and physiological sexual arousal (vaginal pulse amplitude; VPA). Trait anxiety and anxiety sensitivity were correlated with self-reported sexual arousal outside the laboratory. The findings may be interpreted in light of sympathetic nervous system (SNS) influences on sexual arousal and potential cognitive interference mechanisms associated with anxiety.     

Cognitive Coping Tool Kit for Psychosis: Development of a Group-Based Curriculum

This article outlines an 8-week curriculum that was created to help outpatients develop cognitive and behavioral skills for coping with delusions and hallucinations as well as to reduce patients’ comorbid subjective levels of distress (e.g., depression, anxiety). The manualized protocol consisted of psychoeducation and training in a variety of CBT skills that have shown promise in treating individuals with residual psychosis, using recovery-oriented “naturalistic” methods and culminating in the creation of an individualized “tool kit” of cognitive coping resources. A preliminary study of the effectiveness of this brief group-based CBT program for outpatients with chronic, residual symptoms of schizophrenia was conducted. Participants were 24 outpatients diagnosed with schizophrenia spectrum disorders who were stable on medications and connected to case management community follow-up. The Positive and Negative Syndrome Scale for Schizophrenia interview and the Symptom Checklist-90 self-report symptom scales were administered pre- and post-intervention. The results suggest that there were significant improvements in psychotic symptoms and self-reported distress from pre- to posttreatment.     

Evidence-based psychological treatments for late-life anxiety

This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults.     

The structure of anxiety symptoms among preschoolers.

This study examined whether anxiety symptoms in preschoolers reflect subtypes of anxiety consistent with current diagnostic classification systems, or should be better regarded as representing a single dimension. Parents of a large community sample of preschoolers aged 2.5 to 6.5 years rated the frequency with which their children experienced a wide range of anxiety problems. Exploratory factor analysis indicated four or five factors and it was unclear whether separation anxiety and generalized anxiety represented discrete factors. Results of confirmatory factor analyses indicated a superior fit for a five-correlated-factor model, reflecting areas of social phobia, separation anxiety, generalized anxiety, obsessive-compulsive disorder and fears of physical injury, broadly consistent with DSM-IV diagnostic categories. A high level of covariation was found between factors, which could be explained by a single, higher order model, in which first order factors of anxiety subtypes loaded upon a factor of anxiety in general. No significant differences were found in prevalence of anxiety symptoms across genders. Symptoms of PTSD in this sample were rare.     

A test of the tripartite model of depression and anxiety in older adult psychiatric outpatients

This study examined the tripartite model of depression and anxiety in 131 psychiatric outpatients, ages 55-87. Confirmatory factor analyses revealed that a 3-factor model provided an adequate fit to the observed data, that the 3-factor model was empirically superior to 1- or 2-factor models, and that the 3-factor structure obtained in the current sample of older adult outpatients converged with that obtained on a separate, younger 'sample. Negative affect was significantly related to depression and anxiety symptoms and syndromes, and positive affect was more highly related to depression than anxiety symptoms and syndromes. Ways for taking into account possible age-associated differences in emotion in older adults and thus improving the conceptual model of anxiety and depression are briefly noted.     

Social anxiety and perceptions of likeability by peers in children

The current study aimed to investigate the discrepancy between self-reported and peer-reported likeability among children, and the relation with social anxiety, depression, and social support. In total, 532 children between 7 and 12 years completed questionnaires about social anxiety symptoms, depressive symptoms, and social support, estimated their own likeability, and indicated how much they liked their classmates. Children with higher levels of social anxiety or depression overestimated their likeability less or even underestimated their likeability. Social anxiety symptoms, but not depressive symptoms, were significant predictors of the discrepancy. Social support was positively related to likeability and negatively related to social anxiety, but did not moderate the association between social anxiety symptoms and perception accuracy of likeability. These results are in line with cognitive theories of childhood social anxiety, and they stress the importance of using multi-informant measures when studying the relation between social anxiety and social functioning in children.     

Sociotropy-autonomy and situation-specific anxiety

Sociotropy and autonomy are conceptualized as two personality dimensions that relate to individuals' vulnerability to anxiety and depression. Sociotropy is characterized as an excessive investment in interpersonal relationships, and autonomy is characterized as an excessive concern with independence as well as a lack of concern for others. The present study investigated the relationships between sociotropy-autonomy and trait anxiety associated with four types of situations, i.e., Social Evaluation, Physical Danger, Ambiguous Situation, and Daily Routine. 255 undergraduate students completed the Sociotropy-Autonomy Scale, the Endler Multidimensional Anxiety Scale, and the Beck Depression Inventory. Analyses indicated that scores on Sociotropy were positively correlated with rated trait anxiety in situations of Social Evaluation, Physical Danger, and Ambiguous Situations, whereas scores on Autonomy were positively correlated with rated trait anxiety in Daily Routines. These findings are discussed in the context of the diathesis-stress model of anxiety and depression.     

Desirable responding mediates the relationship between emotion regulation and anxiety

Reappraisal and suppression are two commonly studied emotion regulation (ER) strategies. Their trait expression is often assessed through self-report questionnaires. Recent work suggests that trait-reappraisal is generally associated with lower levels of psychopathology while trait-suppression is linked to greater psychopathology. We propose here that the reappraisal construct represents a set of highly desirable traits, whereas suppression represents unwanted characteristics. If this were true, relationships between self-reported ER traits and psychopathology, such as anxiety, might be systematically biased. To test this hypothesis, we examined whether desirable responding (self-deceptive enhancement and impression management) mediated the link between self-reported emotion regulation traits (reappraisal and suppression) and anxiety in a sample of over 4000 college students, controlling for gender and ethnicity. Our findings show support for this hypothesis. Desirable responding, especially self-deceptive enhancement, mediated the effects of ER traits on anxiety. Our findings recommend caution in the use of self-reported ER traits when assessing links to psychopathology and underscore the influence of self-deception in subjective well-being.     

Physiological and subjective measures of anxiety during flooding

Patterns of physiological arousal and subjective reports of anxiety were examined during individual sessions of imaginal flooding of five phobic subjects. A curvilinear pattern of increased, followed by decreased, arousal characterized changes in heart rate, respiration rate and subjective anxiety. Heart rate tended to reach its peak level before respiration rate and subjective anxiety. Intercorrelations between these measures were generally positive and significant. Comparisons between periods of high and low subjective arousal revealed a significantly greater correlation for low than for high arousal only for the subjective anxiety by respiration-rate correlation.     

Transdiagnostic group CBT for anxiety disorders: the unified protocol in mental health services

Comorbidity among the anxiety disorders is common and may negatively impact treatment outcome. Potentially, transdiagnostic cognitive-behavioral treatments (CBT) deal more effectively with comorbidity than standard CBT. The present study tested the effectiveness of The Unified Protocol (UP) applied to Mental Health Services. Pre-post-treatment effects were examined for psychiatric outpatients with anxiety disorders receiving UP treatment in groups. Forty-seven patients (mean-age = 34.1 (SD = 9.92), 77% females) with a principal diagnosis of anxiety were included. We found significant and clinically meaningful changes in the primary outcomes Clinical Global Impression Severity Scale (CGI-S; d = 1.36), Hamilton Anxiety Scale (HARS; d = .71), and WHO-5 Well-being Index (WHO-5; d = .54). Also, comorbid depressive symptoms and levels of positive and negative affect changed significantly after treatment. Patients with high levels of comorbidity profited as much as patients with less comorbidity; however, these patients had higher scores after treatment due to higher symptom burden at onset. Patients with comorbid depression profited more from treatment than patients without comorbid depression. The treatment effects found in the present study correspond to treatment effects of other TCBT studies, other UP group studies, and effectiveness studies on standard CBT for outpatients. The results indicate that the UP can be successfully applied to a MHS group setting, demonstrating positive effects on anxiety and depressive symptoms for even highly comorbid cases.