Pain anxiety among chronic pain patients: specific phobia or manifestation of anxiety sensitivity?

Rather than viewing anxiety among chronic pain patients as simply a component of negative affectivity, investigators have developed a model of "pain anxiety" in which patients develop fear and avoidance of activity linked to pain. We examined whether pain anxiety can be conceptualized as a specific phobia, or whether evidence supported the notion that pain anxiety is better understood as a manifestation of anxiety sensitivity in the context of chronic pain. Chronic musculoskeletal pain patients (N=70) underwent cold pressor and mental arithmetic tasks while cardiovascular, self-report, and behavior indexes were recorded. They completed measures of pain anxiety, anxiety sensitivity, fear of negative evaluation, depression and trait anxiety. Correlation analyses showed pain anxiety was related to pain-relevant responses during cold pressor, but it was also related to evaluation-relevant responses during cold pressor, and to pain- and evaluation-relevant responses (including subtraction accuracy) during mental arithmetic. Regression analyses showed that almost all effects of pain anxiety on task responses were accounted for by anxiety sensitivity. Fear of negative evaluation, in contrast, correlated only with evaluation-relevant responses, and mostly during mental arithmetic. These effects remained significant when depression, trait anxiety, or anxiety sensitivity were statistically controlled. Pain anxiety may be an expression of anxiety sensitivity rather than a circumscribed phobia; a distinction that could profitably guide treatment strategies.     

General self-efficacy,dental anxiety and multiple fears among 20-year-olds in Norway

This paper examines the extent to which low general self-efficacy and painful dental and medical experiences are related to dental anxiety, multiple fears and to avoidance of dental care. A total of 754 20-year-olds completed a series of questionnaires, including the General Self-efficacy Scale (GSE), Geer Fear Scale (GFS) and Dental Fear Survey (DFS). Females had lower self-efficacy, higher dental anxiety and higher scores on the GFS than males. Multivariate analyses (linear stepwise regression) indicated that painful dental experiences, a high score on the GFS and negative opinions about own dental health explained 37% of the variance in DFS scores. Self-efficacy had no predictive power for dental anxiety, and only dental anxiety had predictive power for dental avoidance behavior. Thirty-eight percent of the total variance in GFS scores was explained by the following variables: being a female, high dental anxiety (DFS), low general self-efficacy (GSE) and low educational level of the mother.     

From I: A/M to “Who am I?”—Aggregation/Massification and Trauma-Based Affects and Object Relations in Groups: A Response to Earl Hopper

Hopper's portrayal of the fourth basic assumption of Incohesion: Aggregation/Massification has two components: (1) a revision of Turquet's theory of BA Oneness to incorporate the polarity of aggregation and massification stemming from annihilation anxiety; and (2) a conception of the difficult patient as having an encapsulated psychosis. Hopper's theory of the encapsulated psychosis offers an important but incomplete perspective in explaining borderline and narcissistic pathology, as well as psychological trauma. In this response to Hopper, I suggest that the fourth assumption is in fact a still more primitive state of boundary opening and closing. I also see a need to differentiate trauma as such from borderline pathology, and further hold that the relationship between Hopper's British Independent theory and trauma theories based on dissociation needs to be clarified.     

Social Anxiety Disorder in Childhood and Adolescence: Current Status and Future Directions

This paper reviews the current status of research on the phenomenology, etiology, maintenance, assessment, and treatment of childhood and adolescent social anxiety disorder (SAD). Despite being one of the most prevalent disorders of childhood and adolescence, SAD paradoxically stands as one of the least recognized, researched, and treated pediatric disorders. The small treatment outcome literature provides preliminary support to the effectiveness of various forms of cognitive behavior therapy. The majority of studies to date, however, are limited by inadequate control conditions. Other findings include some support for the utility of parental involvement in treatment, significant advancements in outcome measures (e.g., normative comparisons, indices of naturalistic social functioning), and impressive durability of gains for the majority of treatments. Future directions are suggested, including experimental and naturalistic studies of developmental pathways and maintenance factors, the incorporation of positive psychology constructs (e.g., positive emotions, hope, self-control) in treatment and prevention, and the continued delineation of differences between child, adolescent, and adult manifestations of SAD.     

The Phenomenology of Homesickness in Boys

Homesickness is the distress or impairment caused by an actual or anticipated separation from home. It is characterized by acute longing and preoccupying thoughts of home and attachment objects. This study extended previous research on the phenomenology of childhood homesickness by assessing a sample of 316 boys, ages 8–16, who were spending 2 weeks at a single-sex residential summer camp. Some 18% of the children reported moderate or high levels of homesickness; 7% reported concomitant severe depressive and anxious symptoms. Homesickness intensity was negatively correlated with separation experience and age. It was most commonly associated with depressive symptoms and internalizing behavior problems. For severely homesick boys, intensity increased over time, decreasing just prior to their return home. Preseparation assessment suggested that severely homesick boys had elevated levels of homesickness and negative emotions months before arriving at camp. One-year follow-up data suggested that the intensity of severe homesickness decreased with age and experience. However, severely homesick boys were less likely than other boys to return to camp. The results demonstrate how brief separations can affect children's well-being and attitudes about separations. Severe homesickness is distinct from separation anxiety disorder, but has elements of this and other psychopathologies. Theories of negative emotion, attachment, and coping complement emerging theories of homesickness.     

Effectiveness of the Hamilton Anxiety Rating Scale with Older Generalized Anxiety Disorder Patients

To expand the collection of instruments available for assessment of anxiety in the elderly, this report examined the original and revised Hamilton anxiety scales in a sample of 50 older adults diagnosed with Generalized Anxiety Disorder (GAD) and 93 normal community participants (ages 55–82). Although the revised anxiety scale had better discriminant validity (lower correlation with the revised Hamilton depression scale) than the original anxiety and depression scales, a considerable amount of shared variance still existed (41% shared variance, GAD sample alone; 17% control sample alone; 74% shared variance, both samples combined). Near-perfect group classification was possible using 7 items from the original anxiety scale and 10 items from the revised anxiety scale. Results are discussed in light of their implications for use of the Hamilton anxiety rating scale with older anxiety-disordered patients.     

Anxiety Symptomatology in Mexican-American Adolescents

Mexican-American adults and adolescents in general have been reported to have high levels of anxiety symptomatology. In our study of a tri-ethnic sample of 2528 junior and senior high school students, the Youth Self Report (YSR) version of the Child Behavior Checklist (CBCL) and a sociodemographic questionnaire was used to assess the anxiety symptoms of Hispanic youth. We compared the ratings on anxiety symptoms, using Achenbach's anxiety subscale on the YSR, between two populations. The anxiety levels of youth in coastal southeast Texas (Galveston County) were compared to the anxiety levels of youth in the lower Rio Grande Valley. We found that Mexican-Americans of the Lower Rio Grande Valley scored higher on anxiety symptoms than the tri-ethnic population of Galveston County. Other factors associated with higher anxiety scores for Mexican-American youths included being born outside the US, linguistic fluency, father absent from the home, mother's education, and household size. Multiple regression analyses showed that socio-economic status (SES), family composition, and linguistic fluency had a greater relative impact on anxiety symptomatology than all other factors, both for the total sample as well as for the Mexican-American sample. These results parallel previous findings, with Mexican-American adults, which suggest either higher risk for anxiety symptomatology or a culturally related bias in the reporting of such symptoms.     

The Prediction of Negative Events Associated with Anxiety and Dietary Restraint: A Test of the Content Specificity Hypothesis

The prediction of future negative events was studied in a sample of undergraduate students varying on measures of anxiety and dietary restraint. Cognitive theories of psychopathology hypothesize that the emotional concerns of an individual determine which types of information are most often cognitively processed with a biased interpretation. This prediction has generally been called the content specificity hypothesis. Based upon this aspect of cognitive theory, we hypothesized that a high level of trait anxiety would be associated with higher ratings of the probability of future physically threatening events. In addition, it was hypothesized that a high level of dietary restraint would be associated with lower ratings of the probability of future occurrences of overeating. The results of the study supported these hypotheses. These prediction biases were found to be more pronounced in women, as compared to men. The findings were interpreted as supportive of the content specificity hypothesis.     

Predictors of Self-Reported Anxiety and Panic Symptoms: An Evaluation of Anxiety Sensitivity, Suffocation Fear, Heart-Focused Anxiety, and Breath-Holding Duration

The purpose of this study was to examine the extent to which anxiety-related individual difference variables predict anxious responding when individuals experience aversive bodily sensations. Thus, we explore several psychological and behavioral predictors of response to a single 25-sec inhalation of 20% carbon dioxide-enriched air in 70 nonclinical participants. Predictor variables included anxiety sensitivity, suffocation fear, heart-focused anxiety, and breath-holding duration. Multiple regression analyses indicated that only anxiety sensitivity significantly predicted postchallenge panic symptoms, whereas both anxiety sensitivity and suffocation fear predicted postchallenge anxiety. These data are in accord with current models of panic disorder that emphasize the role of fear of fear in producing heightened anxiety and panic symptoms and help clarify specific predictors of anxiety-related responding to biological challenge.     

A case study of behavioral assessment and treatment of insect phobia

We assessed the academic performance of a 14-year-old boy with insect phobia in the context of feared stimuli. The dependent measure was math calculation rate across three conditions that varied therapist statements about the presence of crickets and the actual presence of live crickets. Subsequent treatment consisted of graduated exposure and contingent rewards for math problem completion. Assessment results indicated that the boy's performance was consistently low in the presence of live crickets but not when he was spuriously informed that crickets were present (the primary referral concern). Treatment results indicated no effect from exposure alone and a dramatic effect when exposure was combined with contingent rewards.