The social phobia and social interaction anxiety scales: An exploration of the dimensions of social anxiety and sex differences in structure and relations with pathology

This study sought to provide information on the Social Phobia Scale (SPS) and Social Interaction Anxiety Scale (SIAS) of Mattick and Clarke (1989) with respect to factor structure, relations with psychopathology, and sex differences. A sample of 200 university students completed the SPS and SIAS and various measures of anxiety symptoms and depression. The results from the factor analyses for the sample as a whole suggest the presence of three factors corresponding to scrutiny fears, social interaction anxiety, and a general level of discomfort in social interactions. The results for men replicated this structure. For women, the three-factor solution demonstrated a blurring between the types of anxiety-provoking situations, and a general discomfort in situations involving differences in social power. In general, the discomfort factor was not correlated with measures of pathology, raising the possibility that uneasiness in these situations represents a process that is not part of social anxiety. The distinction between scrutiny fears and social interaction anxiety was also supported by the pattern of partial correlations that suggests that the presence of scrutiny fears is a stronger predictor of psychopathology than is social interaction anxiety, especially for men.     

Exploratory and confirmatory factor analytic investigations of the Illness Attitudes Scale in a nonclinical sample.

The Illness Attitudes Scale (IAS) assesses fears, beliefs and attitudes associated with hypochondriasis [Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger Publishers.]. Recent factor analytic investigations of the IAS in non-clinical samples have suggested a number of different factor solutions. In study 1, we used principal components analysis with both orthogonal and oblique rotation to better explore the structure of this measure. Using a random selection of 390 participants from a larger pool of 780, a five-factor solution was identified: (1) fear of illness, death, disease and pain, (2) effects of symptoms, (3) treatment experiences, (4) disease conviction and (5) health habits. In study 2, confirmatory factor analysis (CFA) of responses from the remaining 390 students evaluated: (a) a single-factor model, (b) Kellner's original nine-factor model, (c) a four-factor model proposed by Ferguson and Daniel [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a nonclinical population. Personality and Individual Differences, 18, 463-469.], (d) a different four-factor model proposed by Stewart and Watt [Stewart, S. H. & Watt, M. C. (1998). A psychometric investigation of the Illness Attitudes Scale (IAS) in a nonclinical young adult sample. Submitted for publication.] and (e) the five-factor model derived in study 1. Of these models, greatest support was obtained for our five-factor model. However, it was also clear that this model could be improved. Based on the results of the CFA, as well as previous research and theoretical considerations, we tested a revised model in which the health habits factor was deleted. Analysis of the revised model showed that it received the greatest support and could be conceptualized as either four distinct factors or as hierarchical in nature, with four lower-order factors loading on a single higher-order factor. Future directions for research as well as suggestions for scoring and using the IAS with nonclinical samples are discussed.     

Is acoustic startle a viable exposure protocol for posttraumatic stress disorder? A clinical case study

Exaggerated startle is a common symptom (based on Diagnostic and Statistical Manual of Mental Disorders [fourth edition] Criterion D) for many patients with posttraumatic stress disorder (PTSD). Findings from previous studies suggest that exaggerated startle may be due to trauma exposure or pretrauma vulnerability factors for PTSD development. The present clinical case study reports on a patient with PTSD characterized by a very prominent startle response and preference against standard trauma-related exposure strategies. On the basis of recent findings that interoceptive exposure exercises (e.g. shaking head side to side, hyperventilation) elicit trauma-related memories (Wald & Taylor, 2008), the authors sought to determine whether repeated application of an acoustic startle stimulus would serve to diminish the prominent startle response and facilitate exposure and overall symptom reduction by eliciting trauma-related memories. The protocol was successful in eliciting vivid and distressing trauma-related memories. Over the course of seven exposure trials, the patient demonstrated a decrease in distress elicited during the protocol, improved mood, and reduced general anxiety and trauma-related distress. He also reported significantly decreased startle response to loud noises encountered during activities of daily living. Although preliminary, these finding suggest that the acoustic startle protocol may be a viable (interoceptive) exposure strategy for individuals with PTSD, particularly those with exaggerated startle responses and those who are not amenable to standard trauma-related exposure strategies.     

Post-traumatic stress disorder symptoms in United Nations peacekeepers: an examination of factor structure in peacekeepers with and without chronic pain

Recent factor analytic investigations of post-traumatic stress disorder in military veterans suggest that symptoms are best described by either a hierarchical 2-factor model or a 4-factor inter-correlated model. Other recent evidence suggests that post-traumatic stress disorder and chronic pain are intricately related; however, the nature of this relationship is not well understood. Factor analysis provides one method for clarifying this relationship. In study 1, we compared competing models of post-traumatic stress disorder symptom structure in a sample of 400 male United Nations peacekeepers using confirmatory factor analysis. Results indicated that both the hierarchical 2-factor and the 4-factor inter-correlated models provided good fit to the data. In study 2, the reliability of these models was assessed in 427 male United Nations peacekeepers with chronic back pain and 341 without. Group comparisons of the confirmatory factor analysis results revealed that the structure of the hierarchical 2-factor and 4-factor inter-correlated models both provided good fit to the data in both the chronic back pain and the group without. However, the structure of the models for the group with chronic back pain group differed in significant ways from that of the group without chronic back pain. Post-traumatic stress disorder symptoms in military veterans can be adequately conceptualized using either a hierarchical 2-factor or 4-factor inter-correlated model. Chronic pain has a minimal influence on overall factor structure. The hierarchical 2-factor model, while parsimonious, does not provide the degree of symptom detail provided by the 4-factor inter-correlated model. Implications for conceptualization of post-traumatic stress disorder symptoms for patients with chronic back pain and significant post-traumatic stress disorder symptomatology are discussed.     

Coping Styles Mediate Perfectionism Associations with Depression Among Undergraduate Students

To better understand depression among adolescent university students, this study was designed to examine coping style as a potential mediator between perfectionism and depression. Participants comprised 510 undergraduate students from Malaysia. Structural Equation Modelling demonstrated that personal standards perfectionism and task-focused coping style were negatively associated with depression, while emotion-focused coping style, avoidant coping style, and evaluative concerns perfectionism were positively associated with depression. Multiple mediator modelling provided evidence that coping styles partially mediated the relationship between perfectionism and depression. These findings advance current knowledge by suggesting how perfectionism may contribute to depression and may inform the development of more effective prevention and intervention programs for depression.     

Anxiety sensitivity and intolerance of uncertainty: requisites of the fundamental fears?

Fears related to anxiety sensitivity (AS)-illness/injury sensitivity, fear of negative evaluation, and fear of pain-may have important theoretical associations with intolerance of uncertainty (IU). In separate investigations, AS and IU have been independently related to the same anxiety-related psychopathology. AS and IU seem to share a basis in fearing unknown, potentially harmful consequences; however, their inter-relationship remains uncertain. IU regarding a specific stimulus, a physical sensation for example, may result in a variety of interpretations and responses, including the catastrophic appraisals that characterize AS. The association between AS and IU was examined in a sample of 293 undergraduates. Results of confirmatory factor and correlation analyses suggest the two constructs are related, but nonetheless independent. It appears that IU may be a required component of catastrophic misappraisals while being an important construct related to fear and anxiety in its own right. Future research directions and potential applications are discussed.     

Etiology of obsessions and compulsions: a behavioral-genetic analysis

It is unknown whether various types of obsessive-compulsive (OC) symptoms have a common genetic or environmental etiology. For example, it is unknown whether hoarding is etiologically associated with prototypic OC symptoms, such as washing, checking, and obsessing. Also unknown is whether particular OC-related symptoms are etiologically linked to the general tendency to experience emotional distress (negative emotionality). To investigate these and other issues, a community sample of 307 pairs of monozygotic and dizygotic adult twins provided scores on 6 OC-related symptoms (obsessing, neutralizing, checking, washing, ordering, and hoarding) and 2 markers of negative emotionality (trait anxiety and affective lability). Genetic factors accounted for 40%-56% of variance in the 8 phenotypic scores (M = 49% of variance for OC-related symptoms). Remaining variance was due to nonshared (person-specific) environment. More detailed analyses revealed a complex etiologic architecture, where OC-related symptoms arise from a mix of common and symptom-specific genetic and environmental factors. A general genetic factor was identified, which influenced all symptoms and negative emotionality. An environmental factor was identified that influenced all symptoms but did not influence negative emotionality. Each of the 6 types of symptoms was also shaped by its own set of symptom-specific genetic and environmental factors. The importance of genetic factors did not vary as a function of age or sex, and the architecture of general and specific etiologic factors was replicated for participants having relatively more severe OC symptoms. Gene-environment interactions were identified. Implications for an etiology-based classification system are discussed.     

Tolerating Distress After Trauma: Differential Associations Between Distress Tolerance and Posttraumatic Stress Symptoms

Distress tolerance has been implicated in disorders of emotional regulation, such as eating disorders and borderline personality disorder; however, much less attention has been given to distress tolerance in the context of posttraumatic stress (PTS). Several conceptual linkages between distress tolerance and PTS exist. Low distress tolerance may increase negative appraisals, reducing an individual’s propensity to deal with distressing mental symptoms immediately after a trauma. Relatedly, a perceived inability to cope with the distress brought on by trauma-related memories and cues may engender maladaptive coping strategies. The few published studies examining the relationship between distress tolerance and PTS have demonstrated that lower distress tolerance was associated with increased PTS symptomatology, including increased avoidance, hyperarousal, and re-experiencing. The current study sought to replicate and extend the emerging empirical base by examining the relationship between distress tolerance and the four distinct PTS symptom clusters, while controlling for time since the index trauma and depressive symptoms. Results indicated that distress tolerance accounted for significant unique variance in re-experiencing and avoidance but not negative emotionality and hyperarousal symptoms. There was also a strong positive association between the number of traumas endorsed by participants, depression, and PTS symptoms. Findings suggest that distress tolerance is associated with PTS, lending further support to the putative relationship between PTS and distress tolerance. Accordingly, developing treatment protocols designed to increase distress tolerance in individuals affected by PTS may reduce symptom severity and increase coping abilities.