‘Between the woods and frozen lake’: a child psychotherapist’s experiences of developing a grant application for an RCT feasibility study

Drawing on the six stages identified by Henton and Midgley (2012) in the narratives of five child psychotherapists involved in the IMPACT study on their evolving attitudes towards participation in outcome research, this paper explores another child psychotherapist’s internal and external world experiences of writing a National Institute of Health Research grant application for a randomised controlled trial feasibility study. It makes use of the key associations that came to mind on first reading Henton and Midgley’s article, outlines the practical and emotional stages of developing the grant proposal and briefly considers some of the wider implications of this kind of work on a personal, organisational and professional level.     

Effects of 7.5% CO2 inhalation on allocation of spatial attention to facial cues of emotional expression

Increased vigilance to threat-related stimuli is thought to be a core cognitive feature of anxiety. We sought to investigate the cognitive impact of experimentally induced anxiety, by means of a 7.5% CO₂ challenge, which acts as an unconditioned anxiogenic stimulus, on attentional bias for positive and negative facial cues of emotional expression in the dot-probe task. In two experiments we found robust physiological and subjective effects of the CO₂ inhalation consistent with the claim that the procedure reliably induces anxiety. Data from the dot-probe task demonstrated an attentional bias to emotional facial expressions compared with neutral faces regardless of valence (happy, angry, and fearful). These attentional effects, however, were entirely inconsistent in terms of their relationship with induced anxiety. We conclude that the previously reported poor reliability of this task is the most parsimonious explanation for our conflicting findings and that future research should develop a more reliable paradigm for measuring attentional bias in this field.     

Attentional bias in high- and low-anxious individuals: Evidence for threat-induced effects on engagement and disengagement

Attentional bias to threatening visual stimuli (words or pictures) is commonly present in anxious individuals, but not in non-anxious people. There is evidence to show that attentional bias to threat can be induced in all individuals when threat is imposed by threat not of symbolic nature, but by cues that predict aversive stimulation (loud noise or electric shock). However, it is not known whether attentional bias in such situations is still influenced by individual differences in anxiety. This question was addressed in two experiments using a spatial cuing task in which visual cues predicted the occurrence of an aversive event consisting of a loud human scream. Speeded attentional engagement to threat cues was positively correlated with trait anxiety in Experiment 1. Experiment 2 showed that speeded attentional engagement was present only in participants selected for high anxiety but not in low-anxious participants. In both experiments, slower disengagement from threat cues was found in all participants, irrespective of their trait anxiety levels.     

Order of Attainment of the Mental Structures for Five of Piaget's Logical,Infralogical, and Formal Tasks

This study explored the relationship between illegitimate birth and cognitive development among 513 boys on probation. Prior research has shown that being part of a single-parent household leads to diminished verbal capacities and often puts a child in greater danger of abuse and neglect. Frequent abuse is thought to lead to the enhancement of visual and spatial skills relative to verbal skills through a process of “frozen watchfulness”. I hypothesized that illegitimate boys from one-parent homes would have greater verbal-performance discrepancy scores than would boys from other combinations of birth status and family structure. These boys had the lowest verbal IQ and highest performance IQ scores and, hence, the largest discrepancy. These boys also suffered the highest degree of abuse and neglect of all four birth status/family structure combinations studied.     

Seeing through the eyes of anxious individuals: An investigation of anxiety-related interpretations of emotional expressions

The interpretation of emotional states is necessary for successful social communication. Often individuals interpret emotional expressions intuitively and without full cognitive awareness. The aim of the present study was to test whether anxiety would influence affect interpretation in the manner suggested by interpretation bias—the tendency to interpret ambiguous cues in a threatening way. Interpretation of social cues was assessed with the similarity rating task (simtask) in two studies (n₁ = 116, n₂ = 76). The similarity ratings were analysed with a multidimensional scaling (MDS) approach, and the effects of anxiety on the interpretation of emotional expressions were analysed with multilevel modelling. The results of both studies showed evidence for an anxiety-related interpretation bias. High-anxious individuals tended to interpret milder threats as more negative than low-anxious individuals did. The consequences for anxiety research are discussed.     

Mechanisms of visual threat detection in specific phobia

People with anxiety or stress-related disorders attend differently to threat-relevant compared with non-threat stimuli, yet the temporal mechanisms of differential allocation of attention are not well understood. We investigated two independent mechanisms of temporal processing of visual threat by comparing spider-phobic and non-fearful participants using a rapid serial visual presentation task. Consistent with prior literature, spider phobics, but not non-fearful controls, displayed threat-specific facilitated detection of spider stimuli relative to negative stimuli and neutral stimuli. Further, signal detection analyses revealed that facilitated threat detection in spider-phobic participants was driven by greater sensitivity to threat stimulus features and a trend towards a lower threshold for detecting spider stimuli. However, phobic participants did not display reliably slowed temporal disengagement from threat-relevant stimuli. These findings advance our understanding of threat feature processing that might contribute to the onset and maintenance of symptoms in specific phobia and disorders that involve visual threat information more generally.     

Trait anxiety and trait anger measured by ecological momentary assessment and their correspondence with traditional trait questionnaires

Ecological momentary assessments (EMA) of anxiety and anger/hostility were obtained every 25–30 min over two 24-h periods, separated by a median of 6 months, from 165 employees at a university in the Northeast. We used a multilevel trait-state-error structural equation model to estimate: (1) the proportion of variance in EMA anxiety and anger/hostility attributable to stable trait-like individual differences; (2) the correspondence between these trait-like components of EMA anxiety and anger/hostility and traditional questionnaire measures of each construct; and (3) the test–retest correlation between two 24-h averages obtained several months apart. After adjustment for measurement error, more than half the total variance in EMA reports of anxiety and anger/hostility is attributable to stable trait-like individual differences; however, the trait-like component of each construct is only modestly correlated with questionnaire measures of that construct. The 6-month “test–retest” correlations of latent variables representing the true 24-h EMA average anxiety and average anger are quite high (r ? 0.83). This study represents the longest follow-up period over which EMA-based estimates of traits have been examined. The results suggest that although the trait component (individual differences) of EMA momentary ratings of anxiety and anger is larger than the state component, traditional self-report questionnaires of trait anxiety and anger correspond only weakly with EMA-defined traits.     

Is depression the past tense of anxiety? An empirical study of the temporal distinction

It has long been recognised that depression and anxiety share a common core of negative affect, but research on similarities and differences between these two emotions is growing. The focus of the current study was on whether the timing of a triggering event can determine whether the dominant emotional reaction is depression or anxiety. It was hypothesised that aversive events in the past would elicit more depression than anxiety, whereas the same aversive events in the future would elicit more anxiety than depression. We created temporally varied versions of vignettes describing aversive events occurring at either time, and asked participants to rate the extent to which the events would elicit feelings of depression or anxiety. Results indicated that adverse past events elicited much higher ratings of anticipated depression and adverse future events elicited much higher ratings of anticipated anxiety. Implications for understanding these two emotions and depressive and anxiety disorders are discussed.     

Axis I anxiety and mental health disorders among stuttering adolescents

PurposeThe purpose of this study was to evaluate anxiety and psychological functioning among adolescents seeking speech therapy for stuttering using a structured, diagnostic interview and psychological questionnaires. This study also sought to determine whether any differences in psychological status were evident between younger and older adolescents.MethodParticipants were 37 stuttering adolescents seeking stuttering treatment. We administered the Computerized Voice Version of the Diagnostic Interview Schedule for Children, and five psychometric tests. Participants were classified into younger (12–14 years; n = 20) and older adolescents (15–17 years; n = 17).ResultsThirty-eight percent of participants attained at least one diagnosis of a mental disorder, according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; APA, 2000), with the majority of these diagnoses involving anxiety. This figure is double current estimates for general adolescent populations, and is consistent with our finding of moderate and moderate–severe quality of life impairment. Although many of the scores on psychological measures fell within the normal range, older adolescents (15–17 years) reported significantly higher anxiety, depression, reactions to stuttering, and emotional/behavioral problems, than younger adolescents (12–14 years). There was scant evidence that self-reported stuttering severity is correlated with mental health issues. There are good reasons to believe these results are conservative because many participants gave socially desirable responses about their mental health status.DiscussionThese results reveal a need for large-scale, statistically powerful assessments of anxiety and other mental disorders among stuttering adolescents with reference to control populations.Educational Objectives: The reader will be able to: (a) explain the clinical importance of assessing for mental health with stuttering adolescents, (b) state the superior method for adolescent mental health assessment and (c) state a major issue with determining the genuineness of stuttering adolescent responses to psychological assessment.     

Anxiety and speaking in people who stutter: An investigation using the emotional Stroop task

People with anxiety disorders show an attentional bias towards threat or negative emotion words. This exploratory study examined whether people who stutter (PWS), who can be anxious when speaking, show similar bias and whether reactions to threat words also influence speech motor planning and execution. Comparisons were made between 31 PWS and 31 fluent controls in a modified emotional Stroop task where, depending on a visual cue, participants named the colour of threat and neutral words at either a normal or fast articulation rate. In a manual version of the same task participants pressed the corresponding colour button with either a long or short duration. PWS but not controls were slower to respond to threat words than neutral words, however, this emotionality effect was only evident for verbal responding. Emotionality did not interact with speech rate, but the size of the emotionality effect among PWS did correlate with frequency of stuttering. Results suggest PWS show an attentional bias to threat words similar to that found in people with anxiety disorder. In addition, this bias appears to be contingent on engaging the speech production system as a response modality. No evidence was found to indicate that emotional reactivity during the Stroop task constrains or destabilises, perhaps via arousal mechanisms, speech motor adjustment or execution for PWS.Educational objectives: The reader will be able to: (1) explain the importance of cognitive aspects of anxiety, such as attentional biases, in the possible cause and/or maintenance of anxiety in people who stutter, (2) explain how the emotional Stroop task can be used as a measure of attentional bias to threat information, and (3) evaluate the findings with respect to the relationship between attentional bias to threat information and speech production in people who stutter.