The anxiety disorder spectrum: Fear imagery,physiological reactivity,and differential diagnosis∗

Abstract

This review considers recent research assessing psychophysiological reactivity to fear imagery in anxiety disorder patients. As in animal subjects, fear cues prompt in humans a state of defensive motivation in which autonomic and somatic survival reflexes are markedly enhanced. Thus, a startle stimulus presented in a fear context yields a stronger (potentiated) reflex, providing a quantitative measure of fearful arousal. This fear potentiation is further exaggerated in specific or social phobia individuals when viewing pictures or imagining the phobic object. Paradoxically, fear imagery studies with more severe anxiety disorder patients – panic disorder with agoraphobia, generalized anxiety disorder, or anxious patients with comorbid depression – show a blunted, less robust fear potentiated response. Furthermore, this reflex blunting appears to systematically be more pronounced over the anxiety disorder spectrum, coincident with lengthier chronicity, worsening clinician-based judgments of severity and prognosis, and increased questionnaire-based indices of negative affectivity, suggesting that normal defensive reactivity may be compromised by an experience of long-term stress.     

The contributions of arousal and self-focused attention to avoidance in social anxiety

Abstract

Fear of blushing is a specific syndrome generally subsumed under the diagnostic category of social anxiety disorder (SAD). This study aims at gathering preliminary data about an intensive weekend intervention specifically designed for individuals with fear of blushing as the predominant complaint. Treatment consisted of a combination of attention training and behavioral therapy. Thirty-one blushing-fearful individuals meeting the criteria for SAD following the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) were treated in three groups. The study was conducted as an open trial. Full assessments were performed before treatment, six weeks after treatment, and at six-month follow-up. Only fear of blushing, the main outcome criterion, was assessed immediately before and after the treatment weekend. The intensive therapy program was well accepted. Fear of blushing and SAD were significantly reduced and reductions remained stable. At follow-up, nearly two-thirds of the participants achieved significant changes in fear of blushing. Despite the preliminary nature of this study, the condensed format of weekend therapy for treating fear of blushing calls for further investigation.     

Memories of Childhood Threat,Fear of Disclosure and Paranoid Ideation: A Mediation Analysis Using a Nonclinical Sample

This study investigated whether associations between childhood memories of threat and adult paranoia could be partially mediated by factors associated with impeded interpersonal communication (concealment and fear of disclosure of personal and distressing information). University undergraduates (N = 179) completed a battery of psychometric scales. Mediation analysis identified a direct effect between early memories of threat and paranoid ideation (B = 0.11, 95% CI = [0.07, 0.14], p = .00). A mediated effect between these variables was also significant (B = .05, 95% CI = [0.02, 0.07], p = .01). However, although significant associations were identified between memories of threat and each of the mediating variables (self-concealment, fear of self-disclosure, anxiety, depression) only fear of self-disclosure displayed a significant association with paranoid ideation (B = .05, 95% CI = [0.02, 0.07], p = .01).     

Optimism as a predictor of the effects of laboratory‐induced stress on fears and hope

The objective of the current study is to explore optimism as a predictor of personal and collective fear, as well as hope, following laboratory‐induced stress. Students (N = 107; 74 female, 33 male) were assigned randomly to either the experimental (stress—political violence video clip) or the control group (no‐stress—nature video clip). Questionnaires of fear and hope were administered immediately after the experiment (Time 1) and 3 weeks later (Time 2). Structural equation modeling indicated the following: (a) Optimism significantly predicted both fear and hope in the stress group at Time 1, but not in the no‐stress group. (b) Optimism predicted hope but not fear at Time 2 in the stress group. (c) Hope at Time 1 significantly predicted hope at Time 2, in both the stress and the no‐stress groups. (d) Gender did not predict significantly fear at Time 1 in the stress group, despite a significant difference between genders. This study supports previous studies indicating that optimism plays an important role in people's coping with stress. However, based on our research the data raise the question of whether optimism, by itself, or environmental stress, by itself, may accurately predict stress response.     

Treatments Addressing Pain-Related Fear and Anxiety in Patients with Chronic Musculoskeletal Pain: A Preliminary Review

Abstract

This review covers the current cognitive behavioural treatments available to address fear-avoidance beliefs in patients with chronic musculoskeletal pain (CMP). Four types of treatment protocols were identified for inclusion in the review: (a) graded in vivo exposure (GivE); (b) graded activity (GA); (c) acceptance and commitment therapy (ACT); and (d) mixed cognitive behavioural protocols. Most of the research suggests that GivE and ACT result in the best outcomes for treating fear-avoidance beliefs in patients with CMP. There is also a readily apparent paucity of research from North America; indeed, most of the available studies were conducted in the Netherlands and Scandinavia. This relative absence of North American research raises potentially important questions about the role of compensation status and access to care, which differ between countries, on treatment outcome. Implications and directions for future research are discussed.     

Fear of Pain is Elevated in Adults with Co‐Occurring Trauma‐Related Stress and Social Anxiety Symptoms

The aim of this study was to determine whether fear of pain and related fear constructs are elevated in people with co‐occurring trauma‐related stress and social anxiety symptoms relative to people with 1 or neither of these conditions. Eighty students were selected from a larger sample and divided into 4 equal groups comprising those with both high trauma‐related stress and social anxiety symptom scores (TRS/SAS), only high trauma‐related stress symptom scores (TRS), only high social anxiety symptom scores (SAS), or neither (N). Results indicated that the TRS/SAS group had significantly higher scores on all fear of pain measures, anxiety sensitivity, and illness/injury sensitivity than any other group, even when level of current pain was included as a covariate. These findings suggest that people with co‐occurring trauma‐related and social anxiety symptoms are most likely to be fearful of pain and to thereby be at increased risk of developing chronic and disabling pain. Implications for future research and treatment are discussed.     

The Effect of d-Cycloserine on Subliminal Cue Exposure in Spider Fearful Individuals

Research on d-cycloserine (DCS) has demonstrated a significant effect on symptom reduction in human studies that utilized conventional exposure-based approaches. Recent studies have offered promising results for targeting fears through subliminal paradigms. In this double-blind, randomized placebo-controlled study, 45 spider fearful individuals received DCS or placebo pills prior to completing a subliminal cue exposure task to images of spiders. Participants completed self-report questionnaires and a behavioral approach task to a live caged tarantula. After repeated exposure to subliminal spider cues, participants in the DCS group reported a greater reduction in disgust than individuals in the placebo group. No difference was observed in fear ratings. These findings suggest that DCS augments the reduction in disgust in spider fearful subjects after subliminal exposure to spider cues.     

A dirty animal is a scary animal! Effects of disgust-related information on fear beliefs in children

The present study investigated whether disgust-valenced information has an impact on children's fear beliefs about animals. Non-clinical children aged between 9 and 13 years (n=159) were presented with disgust-related and cleanliness-related information about unknown animals (Australian marsupials). Before and after information, beliefs of disgust and fear regarding the animals were assessed. Results showed that disgust-related information not only induced higher levels of disgust but also increased children's fear beliefs in relation to these animals. The other way around, cleanliness-related information decreased levels of disgust and resulted in lower levels of fear. The implications for the role of disgust in the development of animal fear are briefly discussed.     

大学生亲密恐惧的图式干预研究

为研究图式治疗对大学生亲密恐惧的临床疗效,以54名有亲密恐惧问题的大学生为被试,采用支持咨询和图式治疗对比的实验研究,对疗效评估的各项指标进行了重复测量(前测、后测和追踪测量)的方差分析。结果表明干预后图式组亲密恐惧以及情感剥夺、缺陷/羞耻、伤害/疾病的易感性、情感抑制等四个适应不良图式都显著低于支持组,而且干预后图式组人际功能和适应功能等两项心理治疗效果评估指标都显著高于支持组。结论:图式治疗比支持支持咨询能更有效地减轻大学生亲密恐惧。