Couples treatment of agoraphobia: changes in marital satisfaction

Six agoraphobic women and their husbands participated in a group therapy program consisting of exposure and cognitive restructuring. The husbands acted as co-therapists. Ratings of marital satisfaction as well as severity of phobia were filled out independently by both clients and their husbands throughout the course of therapy and at follow-up. Two patterns of relationships among marital satisfaction and severity of phobia emerged. For four couples a parallel relationship was observed in that as phobia improved marital satisfaction increased. For two couples the inverse relationship was noted where improvements in phobia were correlated with decreases in marital satisfaction. The importance of the interpersonal context of agoraphobia and implications for treatment are suggested.     

Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders

The present investigation compared the subjective and physiological effects of emotional suppression and acceptance in a sample of individuals with anxiety and mood disorders. Sixty participants diagnosed with anxiety and mood disorders were randomly assigned to one of two groups. One group listened to a rationale for suppressing emotions, and the other group listened to a rationale for accepting emotions. Participants then watched an emotion-provoking film and applied the instructions. Subjective distress, heart rate, skin conductance level, and respiratory sinus arrhythmia were measured before, during, and after the film. Although both groups reported similar levels of subjective distress during the film, the acceptance group displayed less negative affect during the post-film recovery period. Furthermore, the suppression group showed increased heart rate and the acceptance group decreased heart rate in response to the film. There were no differences between the two groups in skin conductance or respiratory sinus arrhythmia. These findings are discussed in the context of the existing body of research on emotion regulation and current treatment approaches for anxiety and mood disorders.     

Avoidance behavior in panic disorder: the moderating influence of perceived control

The relations among anxiety sensitivity, perceived control, and agoraphobia were examined in 239 patients diagnosed with panic disorder (PD). Most patients exhibited agoraphobia accompanying their PD (98% situational avoidance; 90% experiential avoidance; and 80% endorsed interoceptive fear and avoidance). Anxiety sensitivity and perceived emotional control were associated with agoraphobia, and perceived threat control was found to moderate the relationship between anxiety sensitivity and agoraphobia. Lower levels of perceived control were associated with a stronger relationship between anxiety sensitivity and agoraphobia. Results were consistent for self-reported and clinician-rated agoraphobia. Implications for the role of perceived control in agoraphobia development and treatment are discussed.     

A modern learning theory perspective on the etiology of panic disorder

Several theories of the development of panic disorder (PD) with or without agoraphobia have emerged in the last 2 decades. Early theories that proposed a role for classical conditioning were criticized on several grounds. However, each criticism can be met and rejected when one considers current perspectives on conditioning and associative learning. The authors propose that PD develops because exposure to panic attacks causes the conditioning of anxiety (and sometimes panic) to exteroceptive and interoceptive cues. This process is reflected in a variety of cognitive and behavioral phenomena but fundamentally involves emotional learning that is best accounted for by conditioning principles. Anxiety, an anticipatory emotional state that functions to prepare the individual for the next panic, is different from panic, an emotional state designed to deal with a traumatic event that is already in progress. However, the presence of conditioned anxiety potentiates the next panic, which begins the individual's spiral into PD. Several biological and psychological factors create vulnerabilities by influencing the individual's susceptibility to conditioning. The relationship between the present view and other views, particularly those that emphasize the role of catastrophic misinterpretation of somatic sensations, is discussed.     

The exploitation of regularities in the environment by the brain

Statistical regularities of the environment are important for learning, memory, intelligence, inductive inference, and in fact, for any area of cognitive science where an information-processing brain promotes survival by exploiting them. This has been recognised by many of those interested in cognitive function, starting with Helmholtz, Mach, and Pearson, and continuing through Craik, Tolman, Attneave, and Brunswik. In the current era, many of us have begun to show how neural mechanisms exploit the regular statistical properties of natural images. Shepard proposed that the apparent trajectory of an object when seen successively at two positions results from internalising the rules of kinematic geometry, and although kinematic geometry is not statistical in nature, this is clearly a related idea. Here it is argued that Shepard's term, "internalisation," is insufficient because it is also necessary to derive an advantage from the process. Having mechanisms selectively sensitive to the spatio-temporal patterns of excitation commonly experienced when viewing moving objects would facilitate the detection, interpolation, and extrapolation of such motions, and might explain the twisting motions that are experienced. Although Shepard's explanation in terms of Chasles' rule seems doubtful, his theory and experiments illustrate that local twisting motions are needed for the analysis of moving objects and provoke thoughts about how they might be detected.     

Salvation Events Left Unattended: An Inquiry into the Unconscious

In this essay I celebrate James E. Dittes’ impact on my ministry by reassessing three strategic moments in the church in Providence I served for thirty-three years: a dinner, a Sunday morning summer service, and the replacement of the church’s dome. I try to step outside of the heroic role assigned me back then, into a probing, however painful, investigation of the church’s, and my own, darker side.     

The training & support programme for parents of children with ataxia: a pilot study

The aim of the study was to evaluate the impact of the Training and Support Programme among parents of children with ataxia. A total of 39 parents expressed an interest in the TSP, 27 (mean age 41; range 25-58) returned baseline questionnaires and completed the study. Twenty-four children (mean age 12.5 years, SD=12.4) received the TSP. Data were collected by self-administered questionnaires mailed to parents immediately before attending the TSP and at 4-month follow-up. Interviews were conducted with 10 parents immediately following TSP completion. Comparisons over time revealed significant decreases in parental anxious mood (p=.011), depressed mood (p=.046) and perceived stress (p=.020) and significant improvements in generalized self-efficacy (p=.010), satisfaction with life (p=.045) and parental health status (p=.020). Parents reported improvements in children's mobility, "jumping legs", sleep patterns, energy and activity levels, relaxation, and happiness (e.g., more smiles). Parents felt closer to their children and one parent had become "more accepting" of their child's ataxia. Results indicate that the TSP may enhance the psychosocial well-being of parents of children with ataxia although a randomized controlled trial would be necessary to determine whether the changes reported here are in fact due to attending the TSP.     

The Effects of Anxiety and Depressive Symptoms on Daily Positive Emotion Regulation

Individuals with anxiety and depressive symptoms exhibit disturbances in positive emotion regulation, which may hinder full recovery. By comparison, individuals with strong beliefs regarding their capacity to “savor” or maintain positive emotions (i.e., savoring beliefs) display more adaptive positive emotion regulation. The present daily diary study explores three momentary processes involved in positive emotion regulation, namely positive emotion reactivity, regulatory goals, and regulatory effectiveness, and examines the comparative effects of baseline anxiety and depressive symptoms versus savoring beliefs on such processes in real-life contexts. A sample of 164 nonclinical undergraduates provided baseline measures of anxiety and depressive symptom severity and savoring beliefs prior to completing 14 daily assessments of positive emotions and emotion regulatory responses to daily positive events. Results indicated that higher baseline anxiety and depressive symptom severity were associated with decreased positive emotion reactivity and increased down-regulation of positive emotions; higher baseline savoring beliefs were associated with increased positive emotion reactivity, decreased down-regulation and increased up-regulation of positive emotions. Potential clinical implications are discussed.