Chest pain without coronary artery disease: An exploratory comparison with panic disorder

Recent reports have indicated similarities between patients with persistent chest pain of nonorganic origin and patients with panic disorder. In order to explore this association further, we administered a structured interview and three self-report measures (State-Trait Inventory, Beck Depression Inventory, and SCL90-R) to three subject groups: (1) a sample with persistent chest pain (CP; n=14) who had been screened and found to have normal coronary arteries, (2) a sample of patients with panic disorder (PD; n=14), and (3) a sample of matched normals (n=14). CP patients were considered to be free of coronary artery disease (CAD) following normal cardiac catheterization and/or normal thallium stress tests and were not diagnosed initially with panic disorder. PD patients were diagnosed with a standardized psychiatric interview and were free of organic causes of panic. Using an exploratory data analytic approach, the results indicated that both CP and PD samples reported increased levels of state and trait anxiety (p <.0001), depression (p <.01), and somatization (p <.0001) compared with normals. CP patients differed from PD patients in their less frequent use of anxiolytic medication (p <.01) and lower levels of reported panic anxiety and phobic avoidance (p <.0001). These data suggest that persistent chest pain in the absence of CAD shares some features with panic disorder, yet differs from panic in key ways as well. The results are discussed in light of the role of anxiety in contributing to symptom labeling.This research was supported by Grant 86G-491 from the American Heart Association, Texas Affiliate, to J.G.B. H.T. is the recipient of USPHS Research Career Development Award K04-HL-0122246.     

Introduction to Special Issue. Counselors Be Aware: Clients Come in Every Size,Shape, Color,and Sexual Orientation

In order to guarantee that each individual is free to pursue his/her potential, each member of AACD is charged to (a) engage in ongoing examination of his/her own attitudes, feelings, stereotypic views, perceptions and behaviors that might have prejudicial or limiting impact on women, ethnic, minorities, elderly persons, gay/lesbian persons and persons with handicapping conditions; (b) contribute to an increased sensitivity on the part of other individuals, groups or institutions to the barriers to opportunity imposed by discrimination; (c) advocate equal rights for all individuals through concerted personal, professional and political activity. (Position paper of the Human Rights Committee of the American Association for Counseling and Development, 1987, p.1)     

Gay Identity Issues Among Black Americans: Racism,Homophobia, and the Need for Validation

There is little available literature on gay and lesbian identity among Black Americans. This exploratory study involved interviewing a total of six Black-American gay men and lesbian women regarding gay identity development issues. Data pertaining to the interviewees' experiences of gay identity development were obtained through a questionnaire of six open-ended questions and an interview with each participant lasting 1 to 2 hours. This article presents some of the significant challenges faced by those who were interviewed regarding their sense of self-acceptance, both as Blacks in the predominantly White gay and lesbian community and as gay men and lesbian women in the predominantly heterosexual Black community. The implications of these issues for future research and counseling intervention are discussed. In this article the term gay identity is generally used in reference to both men and women. When women are being discussed exclusively, however, the term lesbian identity is used.     

Lesbian Partner Abuse: Implications for Therapists

Silence surrounds the issue of lesbian battering. Lesbian victims of partner abuse are even less likely than are their heterosexual counterparts to seek help in shelters or from counselors because of the overlay of homophobia that exists both in the battered women's movement and among mental health professionals. In addition, many lesbian and many lesbian-supportive therapists hold an idealized and unrealistic picture of the nature of lesbian relationships, leading them to deny the existence of buttering among lesbian couples. The nature, severity, and prevalence of abuse in lesbian relationships is addressed; current counseling and treatment models dealing with battering relationships are analyzed; and a counselor advocacy model for working with lesbian partner abuse, drawing from the experience of activists in the battered women's movement and our clinical experience, is suggested.     

Incorporating Lesbian and Gay Issues Into Counselor Training: A Resource Guide

In order for counselors to facilitate the growth of their lesbian and gay clients, they must be familiar with and become sensitive to the special needs of this population. However, most counselors and counselor trainees have had little exposure to these needs. One way of increasing their awareness and sensitivity is to incorporate lesbian and gay issues into counselor training programs. The focus of this article is to present a limited list of strategies and resources that can be used to supplement materials in traditional courses in counselor training so as to better prepare counselors for dealing with lesbian and gay clients.     

Combating Homophobia in AIDS Education

Homophobia is a central theme in response to the AIDS epidemic. In this article we review literature explicating the connection between homophobia and AIDS and then call for the integration of antihomophobia elements into AIDS education. We discuss negative messages in portrayals of gay and bisexual men and in discussions of safer sexual practices, as well as materials and educational strategies that explicitly contradict such homophobic messages. We then discuss the emerging trend to exclude lesbian women and gay men in education and programs, suggest guidelines for countering such exclusion, and give examples of creative approaches to inclusion.     

Hans Zacharias Hoxter: Building Counseling Internationally

Counseling is an international phenomenon. This interview presents the lifework of Hans Hoxter and illustrates how the American counseling movement affects and is affected by multinational and multicultural conceptions.     

Assessing the relationship of Type A beliefs to cardiovascular disease risk and psychosocial distress

Investigators have begun to take a multimodal approach to the assessment and treatment of psychosocial risk factors for cardiovascular disease (CVD). For instance, cognitive responses have become the focus of contemporary research along with continued examination of overt Type A behaviors. Price (1982) has outlined a set of beliefs purportedly associated with Type A behavior and subsequent CVD risk. The current study examines the validity of this belief set as represented by a newly developed measure, the Type A Cognitive Questionnaire (TACQ). Subjects were 221 employed adults participating in a worksite CVD risk reduction program. They completed the TACQ as part of a pretreatment CVD risk screening protocol. As hypothesized, TACQ scores were significantly associated with Type A behavior, hostility, physiological mediators of CVD, and psychosocial distress. Discussion addresses continued refinement of the Type A belief construct.