On ‘the fear of death’ as the primary anxiety: How and why Klein differs from Freud

It is well known that Melanie Klein held the view that ‘fear of death’ is the primary source of anxiety and that her position is explicitly opposed to that of Sigmund Freud, who maintained that that fear cannot in any way or form be a source of anxiety. In a previous article on Freud's Inhibitions, Symptoms and Anxiety (Blass, 2013), the author argued that, counter to what is commonly portrayed in the literature, Freud's considerations for rejecting the fear of death as a source of anxiety were based on relational and experiential factors that are usually associated with Kleinian psychoanalysis. In light of this affinity of Freud with Klein a question arises as to the actual source of their differences in this context. The present paper offers an answer to this question. The author first presents some of her earlier findings on what led Freud to reject the fear of death as a source of anxiety and then turns to investigate Klein's considerations for accepting it. This takes us beyond her explicit statements on this matter and sheds new light on the relationship of her views regarding death and anxiety and those of Freud. In turn this deepens the understanding of the relationship of Freud and Klein's conceptualizations of the psyche and its internal object relations, pointing to both surprising common ground and foundational differences.     

Finding theory‐ and evidence‐based alternatives to fear appeals: Intervention Mapping

Fear arousal—vividly showing people the negative health consequences of life‐endangering behaviors—is popular as a method to raise awareness of risk behaviors and to change them into health‐promoting behaviors. However, most data suggest that, under conditions of low efficacy, the resulting reaction will be defensive. Instead of applying fear appeals, health promoters should identify effective alternatives to fear arousal by carefully developing theory‐ and evidence‐based programs. The Intervention Mapping (IM) protocol helps program planners to optimize chances for effectiveness. IM describes the intervention development process in six steps: (1) assessing the problem and community capacities, (2) specifying program objectives, (3) selecting theory‐based intervention methods and practical applications, (4) designing and organizing the program, (5) planning, adoption, and implementation, and (6) developing an evaluation plan. Authors who used IM indicated that it helped in bringing the development of interventions to a higher level.     

Thought Suppression in Spider-Fearful and Nonfearful Individuals

The authors examined the suppression of spider-related thoughts in spiderfearful (n = 23) and nonfearful (n = 22) individuals. Participants were primed with vivid pictures of spiders and a story about spiders. Next, they were randomly assigned to 1 of 2 conditions: (a) suppression of thoughts associated with the previously presented spiderrelated stimuli or (b) free expression of any thoughts, including those related to the spider-related stimuli. All participants completed a subsequent free-expression exercise. Results indicated that spider-fearful individuals expressed thoughts about the spider-related stimuli for a longer length of time than did nonfearful individuals, particularly in the suppression condition. Participants in both groups demonstrated a rebound of thoughts associated with the spider-related stimuli following suppression. The authors propose that the priming of feared stimuli makes suppression of fear-related thoughts particularly difficult for fearful individuals, perhaps by activating a state of heightened arousal.     

Replication of the factor structure of the fear of AIDS schedule (FAIDSS) across samples

Abstract

The stability of the Fear of AIDS Scale (FAIDSS) was studied using three samples (two samples of health workers and one of social work students) on Cattel's s index. Using hyperplane cutoffs between 0.35 and 0.45, on the five factor solution of the FAIDSS, there were significant correlations between factors across samples and with few exceptions each factor correlated significantly with only one factor in its comparison samples. Concurrent validity was demonstrated by comparing scores on the Attitudes toward AIDS scale with the FAIDSS. Data indicated that the FAIDSS structure was stable across samples and is an appropriate instrument for measurement of fear of AIDS in the helping professions.     

The risky side of inspirational appeals in personal selling: when do customers infer ulterior salesperson motives?

In personal selling, the inspirational appeal (IA) is a widely promoted tactic that aims at stimulating customers' values and ideals, thereby evoking emotions and arousing their enthusiasm for a product. However, whether IAs in fact improve or undermine salespeople's success in sales talks remains controversial. Therefore, this study examines consequences and key contingencies of IAs in customer–salesperson interactions in a retailing context, using multisource data from several retailing industries for three quantitative studies, comprising a total sample of 590 customer and 174 salesperson responses. Drawing on the Multiple Inferences Model (MIM), the authors show that an IA is likely to drive the customer's inference that the salesperson holds ulterior motives. IAs seem to be particularly detrimental for salespeople with a lack of customer orientation. Beyond expanding research on influence tactics and the ambivalent role of IAs in retailing interactions, these findings can guide practitioners about when to refrain from using an IA.     

Health care utilisation in patients with non-cardiac chest pain: A longitudinal analysis of chest pain,anxiety and interoceptive fear

Chest pain can be a frightening experience that leads many to seek medical evaluation. The symptom results in costly health care utilisation. Over half of patients referred for cardiac evaluations of chest pain do not obtain definitive medical explanations for their symptoms; these cases are described as non-cardiac chest pain (NCCP). Some patients with NCCP are not reassured after being informed their chest pain is non-cardiac in origin and seek repeated medical evaluation. Co-morbid anxiety and mood disorders often coexist with NCCP and are associated with health care utilisation. The current study examined chest pain, general anxiety, interoceptive fear and health care utilisation in a sample of 196 chest pain patients near the time of cardiac evaluation (Time 1), and 70 of these patients one year later (Time 2). Results indicate that anxiety and interoceptive fear were significantly associated with health care utilisation at Time 1, and only interoceptive fear (at Time 1) predicted health care utilisation at Time 2. This study develops research in this area by examining the relation of anxiety and health care utilisation longitudinally in patients with NCCP.     

Dental anxiety in the elderly

Abstract

This review of the literature shows that dental anxiety in the elderly has been estimated at a much lower level than that found in the general population. However, it is thought that the problem may have been underestimated because older persons may have masked their feelings by minimizing their needs for dental treatment. It is suggested that dentists need to address the special needs of the older dental patients if they wish to have them utilize their services. Older persons' needs can be met only with a greater understanding and tolerance of ageing processes than has been shown in the past. The decrease of dental anxiety with age found in cross-sectional studies needs to be confirmed by longitudinal studies.     

Interventions to prevent skin cancer: Experimental evaluation of informational and fear appeals

Abstract

Reports experimental and correlational analyses of intentional sunbathing in 82 female and 54 male suntanned adults at high-risk of skin cancer. Random assignment to high or low information conditions allowed evaluation of a widely-distributed American Cancer Society pamphlet. A crossed manipulation assigned subjects to a cancer fear/no fear condition. Personality variables served as correlational predictors of sunbathing attitudes, intentions, and information-seeking behaviors; skin cancer knowledge served as both a predictor and a dependent variable. Skin cancer knowledge, but not fear, emerged as a significant predictor of attitudes, intentions, and behaviors; and simple provision of information affected relevant knowledge. Contrary to the limits often encountered with health behaviors, specific cancer education appears to be somewhat effective in this domain, though indirectly. High risk-taking personalities were less likely to have or seek relevant information, suggesting the need to take into account individual predispositions and routes of knowledge acquisition when designing interventions.     

What makes labour and birth traumatic? A survey of intrapartum ‘hotspots’

Evidence suggests between 1% and 6% of women develop post-traumatic stress disorder (PTSD) after childbirth. ‘Hotspots’ are moments of extreme distress during traumatising events that are implicated in symptoms of PTSD. This cross-sectional internet survey of hotspots examined (1) the content of intrapartum hotspots and (2) whether particular events, cognitions or emotions during hotspots are related to PTSD. Women (N?=?675) who experienced a difficult or traumatic birth completed a questionnaire composed of a validated measure of PTSD, questions concerning the existence of hotspots, and a newly developed measure of emotions and cognitions during hotspots. The majority of women (67.4%) reported at least one hotspot during birth and 52.9% had re-experiencing symptoms of these hotspots. Women were more likely to have PTSD if hotspots involved fear and lack of control (odds ratio (OR) 1.30, 95% CI 1.17–1.43) or intrapartum dissociation (OR 1.12, 95% CI 1.05–1.19). Risk of PTSD was higher if hotspots concerned interpersonal difficulties (OR 4.34, 95% CI 2.15–8.77) or obstetric complications (OR 3.35, 95% CI 1.64–6.87) compared to complications with the baby.     

Components of attentional biases in contamination fear: Evidence for difficulty in disengagement

Attentional bias for threat has been implicated in the contamination fear (CF) subtype of obsessive-compulsive disorder, but the components of the bias (facilitated attention versus difficulty in disengagement) and the stage of processing during which the bias occurs (early versus late stage of processing) remains unclear. Further, it is unclear whether attentional biases in CF are towards fear or disgust-related stimuli. The present study examined attentional biases in a group of individuals selected to have elevated CF (n = 23) and a control group (n = 28) using the spatial cueing task. Stimuli were neutral, disgusting, or frightening pictures presented for either 100 or 500 ms. Results revealed evidence for delayed disengagement from both fear and disgust stimuli in the CF group, but not in the control group. The effect appeared to be greater at 500 ms stimulus presentation, but did not appear to differ between fear and disgust stimuli. The CF group was associated with delayed disengagement from threat even when controlling for generic response slowing. Theoretical and clinical implications are discussed.