Effectiveness of the Hamilton Anxiety Rating Scale with Older Generalized Anxiety Disorder Patients

To expand the collection of instruments available for assessment of anxiety in the elderly, this report examined the original and revised Hamilton anxiety scales in a sample of 50 older adults diagnosed with Generalized Anxiety Disorder (GAD) and 93 normal community participants (ages 55–82). Although the revised anxiety scale had better discriminant validity (lower correlation with the revised Hamilton depression scale) than the original anxiety and depression scales, a considerable amount of shared variance still existed (41% shared variance, GAD sample alone; 17% control sample alone; 74% shared variance, both samples combined). Near-perfect group classification was possible using 7 items from the original anxiety scale and 10 items from the revised anxiety scale. Results are discussed in light of their implications for use of the Hamilton anxiety rating scale with older anxiety-disordered patients.     

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.     

Exaggerated anxiety is not unique to CO2 in panic disorder: a comparison of hypercapnic and hypoxic challenges.

Current biological models of panic disorder (PD) assert that this disorder is maintained by hypersensitivity to carbon dioxide (CO2) and related asphyxia cues, which is manifested as an exaggerated suffocation alarm (D. Klein, 1993). Because suffocation can result from both increased CO2 (hypercapnia) and decreased oxygen (O2; hypoxia), this study examined respiratory responding and anxiety during 5% CO2 (a hypercapnic challenge) and 12% O2 (a hypoxic challenge) in 14 PD patients and 14 matched controls (MC). Results demonstrate that irrespective of the source of suffocation, PD patients respond with increased anxiety relative to MC participants. Significant group differences were observed in respiratory functioning, with the PD patients showing higher respiratory rates in response to both challenges. The MC sample demonstrated the expected respiratory responses to both hypercapnia and hypoxia. The findings indicate that PD patients are hypersensitive to alterations in breathing and that this reactivity is not specific to CO2.     

Treatment of PTSD in Older Adults: Do Cognitive-Behavioral Interventions Remain Viable?

The literature examining trauma among older adults is growing, but little is known about the efficacy of empirically supported interventions for PTSD within this population. Clinical writing on this topic often implies that cognitive-behavioral treatments may be ineffective or inappropriate for older adults with PTSD given physical and/or cognitive vulnerabilities. Review of the limited research in this area, however, provides little support for the claim that cognitive-behavioral interventions are ineffective in treating PTSD among the elderly. In an effort to explicate specific issues related to treatment process and outcome among older survivors of trauma, a case series is presented outlining the treatment of three older adults within the context of a structured, cognitive-behavioral group intervention. Observations from this case series suggests that cognitive-behavioral interventions continue to be useful in treating PTSD with this population. Specific treatment issues unique to older adults are explored and recommendations for future research are discussed.     

Relationship between language competence and emotional competence in middle childhood

Research on children's emotional competence has received considerable attention in the last decade, including the role of language. Language competence (LC) and emotional competence (EC) comprise multiple components. These components and their specific interrelations have not been studied sufficiently. In our study, we examined relations between multiple components of LC and EC in a sample of 210 school-age children. Five measures represented LC: receptive vocabulary, verbal fluency, literacy, narrative structure, and the narrative use of evaluative devices. Four measures represented EC: expressive emotion vocabulary, declarative emotion knowledge, awareness of mixed emotions, and facial emotion recognition. Results showed strong positive correlations between LC and EC ranging between r = .12 and r = .45. In particular, receptive vocabulary and literacy were closely related to emotion knowledge and awareness of mixed emotions. A confirmatory factor analysis revealed that there is a common general ability factor for LC and EC. We discuss why receptive vocabulary and literacy might be so strongly related to emotion knowledge in school-age children. Our findings have implications for developmental psychologists, educational research, and speech-language pathologists.     

Executive control and the experience of regret

The experience of regret rests on a counterfactual analysis of events. Previous research indicates that regret emerges at around 6 years of age, marginally later than the age at which children begin to answer counterfactual questions correctly. We hypothesized that the late emergence of regret relative to early counterfactual thinking is a result of the executive demands of simultaneously holding in mind and comparing dual representations of reality (counterfactual and actual). To test this hypothesis, we administered two regret tasks along with four tests of executive function (two working memory tasks, a switch task, and an inhibition task) to a sample of 104 4- to 7-year-olds. Results indicated that switching, but not working memory or inhibition, was a significant predictor of whether or not children experienced regret. This finding corroborates and extends previous research showing that the development of counterfactual thinking in children is related to their developing executive competence.     

Looking at the actor's face: Identity cues and attentional focus in false memories of action performance from observation

Observing another's actions can induce false memories of self-performance. We investigated whether such observation inflation depends on the discriminability between the self and the observed actor. Discriminability was manipulated by presenting actions either with or without a key visual identity cue, i.e., the actor's face. We also examined whether self–other confusions in the face-visible condition depend on attentional focus (directed to the observed action vs. the actor's face). In the action-only condition, observation inflation was significant and greater than in the face-visible conditions, in which the effect was moderated by attentional focus: It persisted under an action focus but was eliminated under a face focus. Findings for correct memories of self-performance suggest that the reduced effect is not merely due to weaker encoding of the actions themselves. We conclude that self–other confusions in action memory are constrained by the availability of distinctive non-self cues during observation, and sustained by a visual focus on observed actions.     

The Value of a Genetic Counselor: Improving Identification of Cancer Genetic Counseling Patients with Chart Review

Advances in genetics are changing cancer care and requiring institutions to maximize the unique skills of genetics professionals. The identification of genetic syndromes is vital for prevention and management of families with high cancer risks. Despite this, high risk individuals who qualify are often not referred. Genetic counselors could review oncology charts to improve identification. A genetics assessment tool developed by NCI Community Cancer Centers Program was used to perform self-assessment of the genetics program. A weekly report of all new oncology patients was provided to a genetic counselor for chart review. In 2010, 58 % of all eligible patients (n?=?152) were offered a genetics evaluation. In 2011 this improved to 70 % (n?=?167), which was a statistically significant difference, X ²(1)?=?5.13, p?=?0.02. By cancer site, ovarian cancer referrals also showed statistically significant improvement, X ²(1)?=?6.36, p?=?0.01. Breast and colon referrals were improved but not significant. Over 10 months, 129 patients were identified through the chart review program. Three were confirmed to have a genetic mutation for a hereditary cancer syndrome. An average week included review of 73 charts for 10 medical oncologists, 4 radiation oncologists, and 4 pediatric oncologists which generated 60–80 min of work for the genetic counselor. This program improved patient identification and quality, and allowed physicians to become more aware of opportunities for genetic counseling and more patients to receive genetic counseling and testing.     

Reading about explanations enhances perceptions of inevitability and foreseeability: a cross-cultural study with Wikipedia articles

In hindsight, people often perceive events to be more inevitable and foreseeable than in foresight. According to Causal Model Theory (Nestler et al. in J Exp Psychol Learn Mem Cogn 34: 1043–1054, 2008), causal explanations are crucial for such hindsight distortions to occur. The present study provides further empirical support for this notion but extends previous findings in several ways. First, ecologically valid materials were used. Second, the effect of causal information on hindsight distortions was investigated in the realm of previously known events. Third, cross-cultural differences in reasoning (analytic vs. holistic) were taken into account. Specifically, German and Vietnamese participants in our study were presented with Wikipedia articles about the nuclear power plant in Fukushima Daiichi, Japan. They read either the version that existed before the nuclear disaster unfolded (Version 1) or the article that existed 8 weeks after the catastrophe commenced (Version 2). Only the latter contained elaborations on causal antecedents and therefore provided an explanation for the disaster. Reading that version led participants to perceive the nuclear disaster to be more likely inevitable and foreseeable when compared to reading Version 1. Cultural background did not exert a significant effect on these perceptions. Hence, hindsight distortions were obtained for ecologically valid materials even if the event was already known. Implications and directions for future research are discussed.     

A Cross-Lagged Panel Approach to Understanding Social Support and Chronic Posttraumatic Stress Disorder Symptoms in Veterans: Assessment Modality Matters

Although there is a strong and consistent association between social support and posttraumatic stress disorder (PTSD), the directionality of this association has been debated, with some research indicating that social support protects against PTSD symptoms, whereas other research suggests that PTSD symptoms erode social support. The majority of studies in the literature have been cross-sectional, rendering directionality impossible to determine. Cross-lagged panel models overcome many previous limitations; however, findings from the few studies employing these designs have been mixed, possibly due to methodological differences including self-report versus clinician-administered assessment. The current study used a cross-lagged panel structural equation model to explore the relationship between social support and chronic PTSD symptoms over a 1-year period in a sample of 264 Iraq and Afghanistan veterans assessed several years after trauma exposure. Approximately a third of the sample met criteria for PTSD at the baseline assessment, with veterans’ trauma occurring an average of 6 years prior to baseline. Two separate models were run, with one using PTSD symptoms assessed via self-report and the other using clinician-assessed PTSD symptoms. Excellent model fit was found for both models. Results indicated that the relationship between social support and PTSD symptoms was affected by assessment modality. Whereas the self-report model indicated a bidirectional relationship between social support and PTSD symptoms over time, the clinician-assessed model indicated only that baseline PTSD symptoms predicted social support 1 year later. Results highlight that assessment modality is one factor that likely impacts disparate findings across previous studies. Theoretical and clinical implications of these findings are discussed, with suggestions for the growing body of literature utilizing these designs to dismantle this complex association.