Issues in diagnosing anxiety disorders

Research progress in the anxiety disorders is predicated on a useful classification system. In this paper, we review the reliability and validity data for theDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III) anxiety disorders and discuss the salient issues associated with both the conceptualization of anxiety disorders and the diagnostic criteria offered in the DSM-III. It is concluded that the diagnostic reliability for these disorders is, overall, satisfactory. A dearth of validity data, however, hinders progress in both the diagnosis and the treatment of the anxiety disorders. Nevertheless, the DSM-III work group has proposed several changes in the diagnostic criteria for the anxiety disorders. We find some of these proposed changes helpful in that they clarify current diagnostic criteria; changes in diagnostic criteria that alter the basic classification schema, however, seem to be premature.Preparation of this paper was supported in part by MIMH Research Grant 1368.On sabbatical leave from Indiana State University.     

Psychopathology in anxiety disorders

Complaints of anxiety, often meetingDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III), criteria for anxiety disorder, are among the most common problems presenting to health practitioners. In spite of the frequency of anxiety and anxiety disorders, little is known about the basic psychopathology of these conditions that would lead to the development of more efficient and effective treatments and possible preventive efforts. Recently, there has been an increase in research on the psychopathology of anxiety disorders from biological, psychological, and social perspectives. The National Institute of Mental Health's Clinical Research Branch sponsored a 2-day workshop of investigators representing diverse research approaches to discuss emerging issues and research practices within the anxiety disorders. Discussions centered on a review of the general areas of classification, phenomenology, and etiology. A selective summary of this workshop is presented along with recommendations for specific research directions.     

Follow-up of a full-scale network assembly

The authors conducted two full-scale network assemblies for the family network of a suicidal adolescent. Findings from the clinical follow-up and telephone interviews with 21 of 65 participants revealed benefits for the index family and the network members who participated in the meetings. A ripple effect in which the participants' own personal networks improved was also demonstrated. Benefits included resolution of a suicidal crisis, better understanding of depression and family stress, more adaptive responses to depression and suicidal risk, and improved personal relationships. No casualties from this intervention were discovered. This report is intended to stimulate future, more systematic outcome studies.     

The importance of assessing treatment integrity: An example in the anxiety disorders

One purpose of this investigation was to examine the importance of assessing treatment integrity in a study evaluating a treatment for specific anxiety disorders. Three subjects, two social phobics and one simple phobic, received self-instruction training (Phase I) followed by exposure and self-instruction training (Phase II) in a multiple baseline across subjects design. All subjects were assessed during a pretreatment baseline and throughout treatment using measures of treatment integrity and measures of change in phobic severity. Improvement took place at different times for different subjects. Measures of treatment integrity, which consisted of monitoring of self-statements as well as practice outside the session, indicated that treatment was not always received as intended and that improvement was correlated with practice. The usefulness of measures of treatment integrity in both clinical and research settings is highlighted.     

Using phantom and imaginary latent variables to parameterize constraints in linear structural models

The most widely-used computer programs for structural equation models analysis are the LISREL series of Jöreskog and Sörbom. The only types of constraints which may be made directly are fixing parameters at a constant value and constraining parameters to be equal. Rindskopf (1983) showed how these simple properties could be used to represent models with more complicated constraints, namely inequality constraints on unique variances. In this paper, two new concepts are introduced which enable a much wider variety of constraints to be made. The concepts, phantom and imaginary latent variables, allow fairly general equality and inequality constraints on factor loadings and structural model coefficients.During the preparation of this article, it was discovered that another researcher, Jack McArdle, had concurrently and independently discovered some of the techniques reported here. While he has chosen not to publish his research, I wish to acknowledge his work. I would like to thank Art Woodward for telling me about sort-of simple structure.     

A logic of message and reply

In this paper we sketch a logic of message and reply. The logic is intended for application in a wide variety of situations, not restricted to the two-person, turn-taking situation. Each message has a body and a vector; the vector specifies the from, to, and the like. To reply to a message, it suffices to give either (1) a complete reply to the body or (2) a corrective reply to at least one presumption derivable from the vector. We discuss the problems of achieving effectiveness and completeness with respect to certain aspects of communication. The results are mixed. In section 9 we argue semi-formally that, in a certain sense, dialogue is necessary. Finally we note that this logic is not a rival of other approaches but may be combinable with them.     

Imagery and argumentation in apologetics: a case study

This essay explores aspects of the relationship between imagery and thought in the work of the English apologist G.K. Chesterton (1874-1936), focusing on the language and imagery of energy and of vision in his work. It attempts to assess both the strengths and the weaknesses of the ways in which imagery and other aspects of this writer's use of language relate to his argumentation. It also explores the possibility that Chesterton's work can shed light on one of the philosophical dimensions of apologetics, namely, apologists’ attempts to present concepts that cannot be explicitly stated, as part of a defence of Christianity. In considering this issue, it brings Chesterton's use of imagery into dialogue with certain images in the work of the philosopher Mary Midgley and the apologist C.S. Lewis. Finally, it draws certain tentative conclusions concerning the role of imagery in relation to argumentation, within the field of apologetics.     

Expanding the Horizontal Call: A Typology of Social Influence on the Call to Ministry

This research examines the social actors and interactions that facilitate seminary students' sense of calling. Drawing from 36 in-depth interviews with first year Masters of Divinity students, we introduce six ideal typical social others who play a formative role in the early stages of a call to ministry: instigators, exemplars, interpreters, affirmers, challengers, and codiscerners. Together, these findings demonstrate that the call to ministry, while deeply personal, emerges through social interactions that facilitate and make plausible a person's sense of calling and that sustain it over time. Extending Richard Pitt's conceptualization of the “horizontal call,” this paper argues that social others help evoke and solidify—not merely legitimate—a personal sense of call. This research also highlights differences in the social structuring of call by gender. Despite considerable gains in the ordination of women, we find that many still face obstacles to experiencing and embracing a call to ministry.     

Reinforcer pathology,probabilistic choice,and medication adherence in patients with multiple sclerosis

The reinforcer pathology model posits that core behavioral economic mechanisms, including delay discounting and behavioral economic demand, underlie adverse health decisions and related clinical disorders. Extensions beyond substance use disorder and obesity, however, are limited. Using a reinforcer pathology framework, this study evaluates medical adherence decisions in patients with multiple sclerosis. Participants completed behavioral economic measures, including delay discounting, probability discounting, and a medication purchase task. A medical decision-making task was also used to evaluate how sensitivity to mild side effect risk and efficacy contributed to the likelihood of taking a hypothetical disease-modifying therapy. Less steep delay discounting and more intense (greater) medication demand were independently associated with greater adherence to the medication decision-making procedure. More generally, the pattern of interrelations between the medication-specific and general behavioral economic metrics was consistent with and contributes to the reinforcer pathology model. Additional research is warranted to expand these models to different populations and health behaviors, including those of a positive health orientation (i.e., medication adherence).     

Does Analytic Thinking Insulate Against Pro-Kremlin Disinformation? Evidence From Ukraine

Pro-Kremlin disinformation campaigns have long targeted Ukraine. We investigate susceptibility to this pro-Kremlin disinformation from a cognitive-science perspective. Is greater analytic thinking associated with less belief in disinformation, as per classical theories of reasoning? Or does analytic thinking amplify motivated system 2 reasoning (or “cultural cognition”), such that analytic thinking is associated with more polarized beliefs (and thus more belief in pro-Kremlin disinformation among pro-Russia Ukrainians)? In online (N = 1,974) and face-to-face representative (N = 9,474) samples of Ukrainians, we find support for the classical reasoning account. Analytic thinking, as measured using the Cognitive Reflection Test, was associated with greater ability to discern truth from disinformation—even for Ukrainians who are strongly oriented towards Russia. We find similar, albeit weaker, results when operationalizing analytic thinking using the self-report Actively Open-Minded Thinking scale. These results demonstrate a similar pattern to prior work using American participants. Thus, the positive association between analytic thinking and the ability to discern truth versus falsehood generalizes to the qualitatively different information environment of postcommunist Ukraine. Despite low trust in government and media, weak journalistic standards, and years of exposure to Russian disinformation, Ukrainians who engage in more analytic thinking are better able to tell truth from falsehood.