Panic disorder: cognitive-behavioral treatment

The effectiveness of an integrated treatment program utilizing cognitive-behavioral therapies for Panic Disorder was examined. Treatment was comprised of Cognitive Model of Panic-derived procedures, Cognitive Therapy and Applied Relaxation Training. Subjects meeting DSM-III-R criteria for Panic Disorder received thirteen 2.5-hr sessions of outpatient therapy in small groups, over a 12-week period. Subjects were given an extensive rationale of the etiology, development and maintenance of Panic Disorder, within the framework of the Cognitive Model of Panic, and controlled behavioral experiments in panic evocation to internal panicogenic cues, cognitive reappraisal of somatic and ideational cues, breathing retraining, Applied Relaxation Training and Cognitive Therapy to identify and remediate maladaptive beliefs and dysfunctional cognitive schemas. A comprehensive assessment battery was given at pre-mid-post-treatment which included measures of tripartite functioning, global severity, panic, fear, anxiety, depression and psychiatric symptomatology. Analyses indicated statistically significant improvements across all outcome domains. All subjects were free of spontaneous (uncued) panic attacks at post-treatment, and all met operationalized criteria for high endstate functioning. These findings are discussed, with recommendations for future research.     

Is the match/mismatch model based on a statistical artefact?

In the match/mismatch model, recently formulated by Rachman and coworkers, it is stated that incorrectly predicted aversive experiences are generally followed by an immediate adjustment of the predictions concerning aversiveness of the next experience. This model can be considered to reflect a psychological process of the formation of expectations. In the present article it is argued that a simple H0 model, assuming that predictions are completely randomly generated by the subject, may account for the same effects. This H0 model is used in a stringent test of empirical data to determine if there are any effects of the discrepancy between prediction and experience on next prediction that exceed the effects explained by the H0 model. Although the H0 model produces effects very similar to the empirically observed effects, there is clear support for the hypothesized influence of the discrepancy between prediction and experience. Therefore, the model appears to reflect 'real' psychological processes and not chance findings.     

Is agoraphobia harder to treat? A comparison of agoraphobics' and simple phobics' response to treatment

Agoraphobia is reputed to be more difficult to treat than simple phobia. In a test of this supposition, 38 agoraphobics and 19 simple phobics were each given 10 sessions of graduated in vivo exposure. They were assessed before and after therapy using a behavioral avoidance test, behavioral diaries, and self-report measures. Analysis of covariance revealed unequivocal posttest differences only on self-assessed disability level; agoraphobics had changed less in their report of global disability immediately following treatment but not at follow-up. Sixty-eight percent of the simple phobics showed clinically significant improvement on avoidance of the Main Phobia, compared with 34% of the agoraphobics. On three other outcome measures, including more precise behavioral measures of phobia, agoraphobics and simple phobics responded equivalently to treatment. Given clinicians' impression about the comparative difficulty in treating agoraphobic clients, fewer differences in treatment response were obtained than were expected. Several possible explanations for this discrepancy are discussed.     

Types and correlates of blood/injury-related vasovagal syncope

This study investigated by interview, the initial syncopal episode of 103 blood/injury-related vasovagal fainters in order to examine two competing hypotheses concerning their origins. Graham (Circulation, 23, 901-906, 1961) postulated that the faint resulted when sympathetic nervous system (SNS) activity ceased on termination of a threat, leaving parasympathetic nervous system (PNS) activation unopposed. Engel [Fainting (2nd edn), 1962; Annals of Internal Medicine, 89, 901-906, 1978] proposed that when in the face of threat with SNS activation, escape is blocked, the PNS becomes activated as the conservation-withdrawal response, leading to syncope. We found cases clearly conforming to each of these formulations as well as some with characteristics of both, and some who fainted in response to blood or injury but with no perception of threat. The Graham and Engel types did not differ in terms of fear or avoidance of blood, injury, or medically-related situations nor did they differ in the frequency with which their parents reported blood/injury-related syncopal episodes. It is proposed that both may be activated by a common psychological mechanism involving cessation of a defensive posture. In contrast, the non-threat fainters showed significantly less medically-related avoidance and had a greater percentage (94%) of parents with positive faint histories.     

The thin ideal, depression and eating disorders in women

It is proposed that a cultural ideal of thinness for women causes depression at a higher rate among women than among men. This model accounts for five currently unintegrated trends in the epidemiology of depression. It explains why: (1) twice as many women as men are likely to be depressed; (2) this sex difference emerges at puberty; (3) this sex difference is only found in western countries; (4) there is more depression today; (5) the average age of onset for depression is younger now than in the past. Four parallel trends in eating disorders can also be accounted for by the same factor.     

Residential environment and self-directedness among older people

Research on the environmental psychology of later life has produced data and theoretical advances that have been incorporated into the design of nursing homes and housing, neighborhood planning, housing policy, and housing-related services for older people. The applications of knowledge have been particularly useful in compensating for behaviors impaired by the physical illnesses that become more prevalent with aging. Some research has also documented environmental transactions made with the intent of choosing, creating, or shaping environments that increase need fulfillment. These two directions of the transactions between the older person and the environment have been characterized as environmental docility and environmental proactivity. The need for more research on promoting opportunities for proactivity in an attempt to raise environmental quality is discussed.     

Alcohol and correspondence between self-report and physiological measures of anxiety

The present study was designed to determine the main effects of alcohol intoxication on self-report and physiological measures of anxiety. Second, we aimed to assess the role of the Marlowe-Crowne Social Desirability (MCSD) scale in predicting the relationship between self-report and physiological indices of anxiety irrespective of drink content. A final purpose of the study was to determine whether the MCSD could account for discrepancies in the effects of alcohol on the two anxiety response systems. Subjects were male social drinkers who received an 0.70 g/kg dose of alcohol or placebo. Results indicated that irrespective of drink content, subjects with high MCSD scores reported lower levels of anxiety than did subjects with low MCSD scores. This relationship was not evident for heart rate. These results for measures of anxiety were not influenced by drink content.     

Unconscious fantasy: developmental and self-psychological considerations

The authors view unconscious fantasy from the perspective of self psychology as a significant addition and emendation of the classical framework. A selective review of the pertinent literature is presented, followed by clinical material illustrating the contribution of self-psychological concepts to the understanding of unconscious fantasy formation.     

The relationship between underpredicted pain and escape

Escape and avoidance that are disproportional to the danger of the pertinent stimulus are important clinical problems that are often related to inaccurate (catastrophic) expectations. One possible source of such expectations is a prior, underestimated aversive experience. In the present experiment the hypotheses that underestimated pain leads to escape and that it leads to avoidance were tested. In order to control for the effect of the intensity of the pain stimulus, a control group that received 20 pain stimuli of high intensity was formed. Subjects in the experimental condition received 17 pain stimuli of low intensity and 3 of (unexpectedly) high intensity (experimentally induced underprediction). Underprediction of the high intensity stimulus was significantly related to escape, but not to avoidance. The results suggest that the way in which avoidance was operationalized accounts for this. The strong support of the hypothesized relationship between underpredicted pain and escape is an important finding, however.