Conceptual,methodological, and clinical issues in the assessment of anxiety disorders

Many conceptual, methodological, and clinical issues remain unresolved in the assessment of anxiety disorders. Despite the prevalence, incidence, chronicity, and severity of anxiety disorders, research efforts and funding have fallen behind with regard both to other disorders and to addressing critical issues in the field. The primary objective of this paper is to provide a scientific critique regarding a number of often ignored yet salient considerations in anxiety-disorders assessment. Critical analyses of and recommendations regarding the multidimensional nature of anxiety, comorbidity, uniformity myths, synchrony, normative comparisons, psychometric properties of measures, and treatment integrity are offered. Finally, promising areas of clinical research are presented to enhance further the current understanding of the complexities inherent in assessing anxiety disorders.Preparation of this paper was supported in part by NIMH Grant MH36299.     

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.     

自闭症和智力障碍儿童行为问题与父母焦虑的关系:育儿压力的中介作用与领悟社会支持的调节作用

为探讨自闭症和智力障碍儿童行为问题与其父母焦虑的关系及其内在作用机制,研究采用问卷法对1023名自闭症和智力障碍儿童父母进行调查。结果表明：(1)自闭症和智力障碍儿童行为问题对父母焦虑具有正向预测作用;(2)育儿压力在儿童行为问题和父母焦虑间起中介作用;(3)儿童行为问题与育儿压力的关系受到领悟社会支持水平的调节,调节作用只在智力障碍儿童父母群体中显著。研究结果有助于揭示自闭症和智力障碍儿童行为问题对父母焦虑的影响及作用机制,对改善自闭症和智力障碍儿童父母育儿压力与焦虑具有一定指导意义。     

祖辈协同教养与幼儿错误信念理解能力的关系:亲子依恋与祖辈同住的作用

为考察祖辈协同教养与幼儿错误信念理解之间的关系以及幼儿亲子依恋的中介作用,采用方便抽样的方法,调查了某城市三所幼儿园345名小班至大班的祖辈协同教养幼儿及其家庭教养人。对幼儿使用操作任务考察错误信念理解能力,对其家庭教养人利用自陈式问卷收集家庭教养方式和亲子依恋等数据。结果显示：(1)祖辈协同教养类型显著影响幼儿的错误信念理解水平和亲子依恋,“有祖辈同住”协同教养幼儿的错误信念理解水平以及依恋的安全性均显著低于“无祖辈同住”协同教养幼儿;(2)亲子依恋在祖辈协同教养的民主信任和教养冲突两个维度与幼儿错误信念理解能力之间分别存在显著的中介作用;(3)祖辈协同教养类型在教养冲突、亲子依恋、错误信念理解能力的中介模型中起调节作用,在“有祖辈同住”条件下,协同教养冲突显著负向预测幼儿的亲子依恋安全感。     

Does authenticity always breed mental health? A cross-cultural comparison between the United States and China

Numerous studies on Western cultures have suggested a strong linkage between authenticity and mental health. However, little is known about whether such an association can be generalized to Eastern cultures. This study aimed to conduct a cross-cultural comparison on the association between three dimensions of authenticity (authentic living, self-alienation, and accepting external influence) and two factors of mental health (negative and positive) across Western and Eastern cultures. Measurement invariance tests were carried out and multigroup structural regression models developed on two college samples from the US (n = 392) and China (n = 281). Results suggested that the associations between authenticity and the negative factor of mental health were consistent across cultures, where both self-alienation and accepting external influence were positively associated with anxiety. However, the associations between authenticity and the positive factor of mental health were different in the US and Chinese samples. Specifically, both authentic living and accepting external influence were significantly associated with life satisfaction in the US sample but not in the Chinese sample. Findings stress that having a nondistorted perception of the true self is critically related to lower levels of anxiety across cultures and highlighted the need to identify culture-specific promotive factors for life satisfaction.     

“It's wrong to relax,you have to be on the go,go, go,all the time”: Emotional transformation in a case of emotion-focused therapy for generalised anxiety disorder

Generalised anxiety disorder (GAD) is a highly prevalent, chronic and impairing disorder. The aim of this study was to qualitatively describe the transformation in emotional processing across 16 sessions of a successful emotion-focused therapy (EFT) treatment for GAD. A theoretical framework derived from the EFT model of in-session emotional transformation proposed by Pascual-Leone and Greenberg was used as the basis for qualitative analysis. Additionally, the Classification of Affective Meaning States, the Client-Expressed Arousal Scale-III and the Client Emotional Productivity Scale-Revised were utilised by observer–raters to classify moment-by-moment shifts in client affective-meaning states, emotional arousal and emotional productivity. Results supported the emotion transformation model. The client presented in a state of poorly differentiated but highly aroused distress provoked by identifiable interpersonal and intrapersonal triggers. Emotional and behavioural avoidance provoked by fear of pain was evident. Accessing core pain and responding to attendant needs with compassion and protective anger was shown to facilitate the higher order emotional processing states of grief, relief and agency. Implications are proposed, including that addressing core emotional vulnerability may be a critical intervention in the successful treatment of GAD.     

Examining Safety Behavior Subtypes Across Distinct Social Contexts in Social Anxiety Disorder and Major Depression

People with social anxiety disorder (SAD) use different types of safety behaviors that have been classified as avoidance vs. impression management. The current study investigated differences in safety behavior subtype use in 132 individuals with principal diagnoses of social anxiety disorder (SAD, n = 69), major depressive disorder (MDD, n = 30), and nonpatient controls (n = 33) across two social contexts: an interpersonal relationship-building task (social affiliation) and a speech task (social performance). We examined whether diagnostic groups differed in safety behavior subtype use and whether group differences varied by social context. We also explored relationships between avoidance and impression management safety behaviors, respectively, and positive and negative valence affective and behavioral outcomes within the social affiliation and social performance contexts. Safety behavior use varied by diagnosis (SAD > MDD > nonpatient controls). The effect of diagnosis on impression management safety behavior use depended on social context: use was comparable for the principal SAD and MDD groups in the social performance context, whereas the SAD group used more impression management safety behaviors than the MDD group in the social affiliation context. Greater use of avoidance safety behaviors related to higher negative affect and anxious behaviors, and lower positive affect and approach behaviors across contexts. Impression management safety behaviors were most strongly associated with higher positive affect and approach behaviors within the social performance context. These findings underscore the potential value of assessing safety behavior subtypes across different contexts and within major depression, in addition to SAD.     

依恋对象回应方式对不同依恋类型幼儿支持提供预期修正的影响

依恋对象的敏感性回应是儿童安全依恋发展的重要前因。研究采用改编版依恋预期范式考察实时互动情境中依恋对象确定性和概率性回应对幼儿支持提供预期及预期修正的影响。结果发现：相对不安全型依恋幼儿,初始预期中安全型幼儿更多预期依恋对象会向依恋者提供支持;幼儿能够基于依恋对象的确定性和概率性回应一致地修正对该对象是否提供支持的预期。同时,低水平回应对幼儿预期修正的影响高于高水平回应。研究表明5岁左右幼儿能够基于实时互动中依恋对象的回应信息修正其对该依恋对象的预期,这对理解幼儿依恋表征的发展具有重要启示。