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.     

Depression and unemployment: Panel findings from the Epidemiologic Catchment Area study

Studies that have found an association between unemployment and psychological depression often fail to establish the direction of causal influence. Analyses of Epidemiologic Catchment Area panel data revealed that of employed respondents not diagnosed with major depression at first interview, those who became unemployed had over twice the risk of increased depressive symptoms and of becoming clinically depressed as those who continued employed. Although the increase in symptoms was statistically significant, the effect on clinical depression was not, possibly because of the low power of the test. The reverse causal path from clinical depression at Time 1 to becoming unemployed by Time 2 was not supported. The unemployment rate in the respondent's community at time of interview was not related directly to psychological depression but appeared associated indirectly with depression via its impact on the risk of becoming unemployed. Implications for policy and further research were discussed. The research described in this paper was supported by Grant #5 RO1 AA08379-02 from the National Institute of Alcohol Abuse and Alcoholism. The authors appreciate the suggestions provided by members of the Consortium for Research Involving Stress Processes sponsored by the W. T. Grant Foundation and by two anonymous journal reviewers.     

Electrodermal lability in anxiety disorders

Twenty-eight anxiety patients, aged below 50 years, were diagnosed according to DSM-III-R criteria (panic disorder with and without agoraphobia, generalised anxiety disorder, and anxiety disorder not otherwise specified). The patients were characterised by high levels of state and trait anxiety and neuroticism, compared with the controls. However, there were no differences between patients and controls in electrodermal habituation rate, non-specific activity, or skin resistance level. When the patients were divided into electrodermally labile and stable subjects, significant differences were found between patients and controls in both electrodermal activity and Eysenck's personality dimensions. The labile patients were more introverted and attained higher psychoticism scores than either the stable patients or controls. Duration of anxiety symptoms removed the difference found in extroversion, but not in any other variable. The results are discussed in relation to the utility of electrodermal measurements in validation of diagnostic entities. It is concluded, that from the psychophysiological point of view, anxiety disorders may be examined within a dimensional framework.     

Pre-screening education in multiple marker screening programs: The effect on patient anxiety and knowledge

Previous studies have shown that unexplained deviations in maternal serum multiple marker screening (MMS) generate considerable anxiety during the remainder of pregnancy. While the role of education in decreasing anxiety is documented, to date there has been no prospective evaluation of which educational practices might minimize this emotional stress. In a pilot study, we prospectively examined the effects on anxiety and knowledge by providing information about MMS (1) by genetic counselor, (2) by pamphlet, and (3) by primary physician. Women randomized to one of these three modalities were administered the Spielberger State- Trait Anxiety Inventory [STAI] and knowledge questionnaires at their initial obstetrics visit, at their second visit after educational intervention and 1–2 weeks after MMS results were provided to patients. Education resulted in an increase in knowledge and post-education knowledge was different between educational modalities. Anxiety declined in patients educated through genetic counseling or a pamphlet.     

The impact of confederate responsivity on social skills assessment

The current investigation examined the degree to which judges' ratings of skill, anxiety, and attractiveness are influenced by the responsivity of the confederate. High-, medium-, and low-skilled subject-pool groupings, as well as self-referred clinical groups, were exposed to either a moderately or a minimally responsive confederate. Results indicated that subjects were rated as more skillful when interacting with a moderately responsive confederate than when interacting with a minimally responsive confederate. Further, there was a groups × condition interaction for anxiety ratings such that both the high- and the medium-skilled groups appeared more anxious under the minimal condition, whereas the low-skilled and self-referred groups did not. Self-referred subjects received significantly lower attractiveness ratings than did the high- or medium-skilled groups. Implications of these results and future directions for research are discussed.This research is based on a M.S. thesis carried out by the first author under direction of the second author.     

Effects of stress and retesting on role play tests of social skill

The purpose of this study was to examine the role of stress in performance on role play tests of social skill. Chronic psychiatric patients were tested in a formal videotape studio or in an informal consulting room setting. Motoric and physiological measures were secured. In addition, one-half of the subjects were retested one week later. In contrast to previous studies, results indicated that the assessment was not stressful. The two groups were not different on any measure, and the mean heart rates ranged from only 80 to 84 b.p.m. The effects of retesting were difficult to interpret. There were reductions in motoric indices of anxiety (speech disruptions) but not on physiological indices. Overall, testretest reliability was quite high. The results raise several questions which affect interpretation of many social skills studies in the literature.     

Personality factors in dysphoria: A psychometric refinement of beck's Sociotropy-Autonomy Scale

The Sociotropy-Autonomy Scale (SAS) was developed as a means of assessing two cognitive-personality constructs postulated as vulnerability factors in depression (Beck, 1983). While studies have confirmed the validity of the SAS Sociotropy Scale, the construct validity of the Autonomy Scale has not been well supported. The present study was conducted to improve on the measurement of autonomy by generating additional items which were added to the original questionnaire. This 93-item SAS was administered to 485 undergraduates along with the Beck Depression Inventory, Beck Anxiety Inventory, PRF Affiliation and Autonomy Scales, Positive and Negative Emotionality Measures, and Marlowe-Crowne Social Desirability Scale. Four factors labeled Sociotropy, Solitude/Interpersonal Insensitivity, Independence, and Individualistic Achievement emerged from a principal-factor analysis of the SAS item pool. Hierarchical multiple regression analyses indicated that positive emotionality and solitude/interpersonal insensitivity were specifically related to dysphoria, while negative emotionality and sociotropy had significant associations with both anxious and depressed mood states.This research was supported by University of New Brunswick Research Grant 22–51 awarded to the first author.     

The adequacy of a role play of a previous event as affected by high and low social anxiety and rehearsal

This study was designed as a preliminary step in evaluating the adequacy of a role play of a previous event. Sixty undergraduate males, high or low in social anxiety, interacted with a female assistant. Two groups of subjects then rehearsed this conversation overtly or covertly, while a third group became involved in a distraction task. Finally, all subjects role played the initial interaction with a second female assistant. Individual Pearson product-moment correlations between the initial and the role-play sessions yielded moderate, but significant correlations for most of the rated behaviors. Canonical correlations for the verbal and for the nonverbal ratings showed the two sessions, as a whole, highly related. Two (high-versus low-social anxiety group) × three (overt, covert, or no rehearsal) analyses of variance were performed on four measures. Significant results were found only for the anxiety group effect and rehearsal group effect on one rating, anxiety behaviors. The implications of the modest individual correlations suggest that estimation of specific levels of behavior is not appropriate from a role play of a previous event. However, the use of such a role play to make global distinctions of relative competence may be appropriate. The results of this study are consonant with earlier studies on role-play assessment.This article is based on a master's thesis completed by the first author in partial fulfillment of the requirements for the Master of Science degree at Ohio University.     

Racism: What It Is and What It Isn't

The words `racist' and `racism' have become so overused that they nowconstitute obstacles to understanding and interracial dialogue aboutracial matters. Instead of the current practice of referring tovirtually anything that goes wrong or amiss with respect to race as`racism,' we should recognize a much broader moral vocabulary forcharacterizing racial ills – racial insensitivity, racial ignorance,racial injustice, racial discomfort, racial exclusion. At the sametime, we should fix on a definition of `racism' that is continuouswith its historical usage, and avoids conceptual inflation. Isuggest two basic, and distinct, forms of racism that meet thiscondition – antipathy racism and inferiorizing racism. We should alsorecognize that not all racially objectionable actions are done froma racist motive, and that not all racial stereotypes are racist.