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Understanding Anxiety Disorders from a "Triple Vulnerability" Framework
Abstract
This chapter provides a review of research findings on the nature of anxiety and panic, and a summary and update of Barlow's (1988, 2000, 2002) theory of triple vulnerability in the etiology of anxiety and its disorders. A description of the nature of anxiety is followed by an explication of the emotion of fear, and panic. A model of an integrated set of vulnerabilities is summarized, including a generalized biological (heritable) vulnerability, a generalized psychological vulnerability based on early experiences that contributes to the development of a sense of control over salient events, and a more specific psychological vulnerability associated with learning experiences that serve to focus anxiety on specific objects or situations.
... Barlow (2002) proposed the triple vulnerability model of anxiety wherein biological and psychological vulnerabilities when combined with life stress may result in specific anxiety disorders. For example, social anxiety disorders develop from learning experiences that focus on heightened social evaluations and bodily sensations in particular situations (Suarez, Bennett, Goldstein, & Barlow, 2009). The underlying features of anxiety disorders such as attention and automatic responses towards threat occur in milliseconds and may provoke subsequent responses such as the selection of a particular ER strategy to reduce the negative threatful experience. ...
... This is also consistent with Barlow's triple vulnerability model (2002) which underlines that biological and psychological vulnerabilities in combination with life stress may result in anxiety disorders. For example, social anxiety disorder develops from previously learned experiences of focusing on heightened anxiety (Suarez et al., 2009). This is in line with data showing that socially anxious individuals are more vigilant to negative stimuli due to their negative automatic thoughts explaining their attentional bias (Mogg & Bradley, 2002), which is also consistent with the cognitive model of social anxiety (Clark & Wells, 1995;Rapee & Heimberg, 1997), posing that attention can be directed to negative stimuli but safety behaviors can elicit avoidance as a behavior. ...
Maladaptive coping mechanisms influence health-related quality of life (HRQoL) of individuals facing acute and chronic stress. Trait emotional intelligence (EI) may provide a protective shield against the debilitating effects of maladaptive coping thus contributing to maintained HRQoL. Low trait EI, on the other hand, may predispose individuals to apply maladaptive coping, consequently resulting in lower HRQoL. The current research is comprised of two studies. Study 1 was designed to investigate the protective effects of trait EI and its utility for efficient coping in dealing with the stress caused by chronic heart failure (CHF) in a cross-cultural setting (Pakistan vs Germany). N = 200 CHF patients were recruited at cardiology institutes of Multan, Pakistan and Würzburg as well as Brandenburg, Germany. Path analysis confirmed the expected relation between low trait EI and low HRQoL and revealed that this association was mediated by maladaptive metacognitions and negative coping strategies in Pakistani but not German CHF patients. Interestingly, also the specific coping strategies were culture-specific. The Pakistani sample considered religious coping to be highly important, whereas the German sample was focused on adopting a healthy lifestyle such as doing exercise. These findings are in line with cultural characteristics suggesting that German CHF patients have an internal locus of control as compared to an external locus of control in Pakistani CHF patients. Finally, the findings from study 1 corroborate the culture-independent validity of the metacognitive model of generalized anxiety disorder. In addition to low trait EI, high interoception accuracy (IA) may predispose individuals to interpret cardiac symptoms as threatening, thus leading to anxiety. To examine this proposition, Study 2 compared individuals with high vs low IA in dealing with a psychosocial stressor (public speaking) in an experimental lab study. In addition, a novel physiological intervention named transcutaneous vagus nerve stimulation (t-VNS) and cognitive reappraisal (CR) were applied during and after the anticipation of the speech in order to facilitate coping with stress. N= 99 healthy volunteers participated in the study. Results showed interesting descriptive results that only reached trend level. They suggested a tendency of high IA individuals to perceive the situation as more threatening as indicated by increased heart rate and reduced heart rate variability in the high-frequency spectrum as well as high subjective anxiety during anticipation of and actual performance of the speech. This suggests a potential vulnerability of high IA individuals for developing anxiety disorders, specifically social anxiety disorder, in case negative self-focused attention and negative evaluation is applied to the (more prominently perceived) increased cardiac responding during anticipation of and the actual presentation of the public speech. The study did not reveal any significant protective effects of t-VNS and CR. In summary, the current research suggested that low trait EI and high IA predicted worse psychological adjustment to chronic and acute distress. Low trait EI facilitated maladaptive metacognitive processes resulting in the use of negative coping strategies in Study 1; however, increased IA regarding cardioceptions predicted high physiological arousal in study 2. Finally, the German vs. the Pakistani culture greatly affected the preference for specific coping strategies. These findings have implications for caregivers to provide culture-specific treatments on the one hand. On the other hand, they highlight high IA as a possible vulnerability to be targeted for the prevention of (social) anxiety.
... Specifically, the triple vulnerability model has received most attention in the literature and is currently considered the most comprehensive model explaining the etiology and maintenance of emotional disorders from a transdiagnostic approach (Suárez et al. 2009). In this model, the interaction between highly temperamental personality factors like extraversion and neuroticism (general biological vulnerability), early learning experiences and stressful life events (specific psychological vulnerability), and early experiences that have influenced the sense of unpredictability and uncontrollability of life events and emotions (general psychological vulnerability) are argued to underlie the onset and maintenance of emotional disorders. ...
... The transdiagnostic approach of psychopathology has identified a number of vulnerability factors, including perceived control over emotional reactions to threats, which are argued to be shared by different emotional disorders (Suárez et al. 2009). The identification of these vulnerability factors has relevant implications in the prevention and treatment of emotional disorders. ...
Early experiences appear to influence the sense of unpredictability and uncontrollability of both life events and emotions in vulnerable individuals. The perception of low control has been considered a general psychological vulnerability factor in emotional disorders. One of the most commonly used measures of perceived control is the Anxiety Control Questionnaire-Revised (ACQ-R). However, its internal structure has shown structural inconsistencies among several studies finding two or three factors. Our aim is to analyze the internal structure of the Portuguese adaptation of the ACQ-R in a general population sample of 267 individuals, in a confirmatory way, as well as to explore sources of validity evidence (i.e., correlations with the Depression Anxiety Stress Scales and the Positive and Negative Affect Schedule). A three-factor solution showed the best data fit(χ² = 150.12, degrees of freedom = 87, p < .0001, Root Mean Square Error Approximation = 0.052, 90% Confidence Interval = 0.038–0.066, Confirmatory Fit Index = 0.935, Tucker Lewis Index = 0.921). We found moderate positive correlations between the ACQ-R dimensions and anxiety, depression, stress, and negative affect, as well as between small and moderate negative associations with positive affect. All measures presented satisfactory Cronbach alphas (from .77 to .92). The Portuguese version of the ACQ-R showed good psychometric properties and the same internal structure of its original version.
... ASSEN ALLADIN AND JON AMUNDSON Barlow, 1995;Tsao, Lewin, & Craske, 1998;Tsao, Mystkowski, Zucker, & Craske, 2002). Barlow (1991Barlow ( , 2000Barlow ( , 2002Suarez, Bennett, Goldstein, & Barlow, 2009), in his triple vulnerability theory, has described in detail how a set of vulnerabilities or diatheses can interact to produce anxiety and mood disorders. The triple vulnerability theory incorporates three sets of predisposition that interact to produce symptoms: (a) generalized biological vulnerability, (b) generalized psychological vulnerability, and (c) specific psychological vulnerability emerging from early learning. ...
... Posthypnotic suggestions are routinely delivered during hypnotherapy to counter problem behaviors, negative emotions, dysfunctional cognitions, negative self-hypnosis (NSH), and negative self-affirmations. Based upon the triple vulnerability theory (Barlow, 1991(Barlow, , 2000(Barlow, , 2002Suarez, Bennett, Goldstein, & Barlow, 2009) with emotional disorders are predisposed to reflexively ruminate with negative self-suggestions, particularly after experiencing a negative affect (e.g., "I will not be able to cope."). This can be regarded as a form of NSH; negative posthypnotic suggestion that maintains the anxious or depressive cycle. ...
This article describes cognitive hypnotherapy (CH), an integrative treatment that provides an evidence-based framework for synthesizing clinical practice and research. CH combines hypnotherapy with cognitive-behavior therapy in the management of emotional disorders. This blended version of clinical practice meets criteria for an assimilative model of integrative psychotherapy, which incorporates both theory and empirical findings. Issues related to (a) additive effect of hypnosis in treatment, (b) transdiagnostic consideration, and
... And unpredictable circumstances. Studies have shown that social anxiety disorder is associated with difficulty tolerating the level of uncertainty associated with this relationship indicates ambiguity or uncertainty is particularly important for the formation and maintenance of the disorder Key [54][55] . This also supports the amygdala's role in maintaining and maintaining social anxiety. ...
Depression and anxiety disorders are prevalent mental illnesses, and their aetiology is intricate and remains incompletely elucidated. In recent years, researchers in both domestic and international settings have conducted a substantial amount of research on the pathological mechanisms and treatment methods of depression and anxiety disorders. This paper presents a summary of the pathogenesis of depression from the perspective of brain function and structure. It identifies abnormalities in brain regions, including the hippocampus and prefrontal lobe, as being closely related to the condition. These abnormalities are manifested in a reduction in cortical area and volume, as well as impairment of neuronal morphology and ultrastructure in these brain regions. Furthermore, patients with depression are frequently linked to diminished cerebral blood flow, reduced metabolism, aberrant brain network connections and an imbalance in neurophysiological activity. In contrast, patients with anxiety disorders display functional abnormalities in the amygdala, default mode network, cognitive control network and motivational network. These clinical studies have provided new ideas for treatment, and many of them have proposed innovative treatment concepts that are worthy of further investigation and application in clinical practice. This article provides a summary of the progress of research on the brain mechanisms of depression and anxiety disorders, with the aim of providing a reference for their diagnosis and treatment. Further in-depth study of brain function and structural abnormalities in these disorders may facilitate the development of more effective treatments, thereby improving the quality of life of patients.
... The theory suggests modifying the fear structure because pathological fear structures cause heightened self-focused attention and negative affect, causing anxiety symptoms (Foa et al., 2006;Suárez et al., 2008). Exposure therapy contains a repeating and systematic confrontation with imaginal exposures (Rauch & Foa, 2006). ...
Background and objectives:
Virtual reality exposure therapy offers a unique opportunity to treat social anxiety disorder. This meta-analysis aims to evaluate the effectiveness of virtual reality exposure therapy compared to waitlist comparators or other interventions for individuals with social anxiety disorder in alleviating anxiety symptoms.
Methods:
A three-step comprehensive search for the randomized controlled trials of virtual reality exposure therapy was conducted from inception to 7 December 2023. The overall effect was measured using Hedges' g and determined using t-statistics at a significance level of p < 0.05. Sensitivity, subgroup, and meta-regression analyses were carried out.
Results:
A total of 17 randomized control trials were retrieved from nine electronic databases. Virtual reality exposure therapy has greater efficacy than waitlist comparators in reducing anxiety symptoms at post-intervention and follow-up assessment. Virtual reality exposure therapy demonstrates a similar effect to other interventions at post-intervention and follow-up assessment. We observed a greater effect for participants with symptomatic social anxiety when we combined the intervention with cognitive behavioral therapy compared to its counterpart. Meta-regression analyses found no significant covariate.
Conclusions:
Overall, virtual reality exposure therapy can provide supplementary therapy for improving anxiety symptoms. Additional high-quality and large-scale trials with long-term follow-up are needed.
... Neuroticism predicts various undesirable outcomes (E. D. Beck & Jackson, 2022;Soto, 2019) and accounts for much of the genetic vulnerability underlying common mental disorders (Gupta et al., 2024;Hettema et al., 2006;Kendler et al., 2019;Khan et al., 2005;Krueger, 1999), particularly depression and anxiety (Griffith et al., 2010;Suárez et al., 2009;Weinstock & Whisman, 2006). Moreover, the public health costs of neuroticism surpass those associated with these disorders (Cuijpers et al., 2010), in part because neuroticism is relevant to all people. ...
There is evidence that many people want to be less neurotic, that neuroticism can be changed through intervention, and that these changes can have important consequences for individuals’ lives. The potential utility of neuroticism interventions hinges on a thorough theoretical understanding of effective change mechanisms, though. To guide the development of theories of targeted neuroticism change, and effectively implement large-scale intervention efforts, we systematically reviewed the literature on interventions for neuroticism and related constructs in nonclinical samples. In doing so, we provide an overview of this heterogeneous research, identify limitations, and create a taxonomy of intervention strategies for a range of neuroticism-related constructs that can be mapped onto existing process theories of personality change. This framework integrates previous research and offers a common language to guide the future development and systematic testing of specific, testable hypotheses about the mechanisms of intentional neuroticism change.
... Indeed, high school art students with IU are likely to interpret uncertain information as threatening (19), contributing to significant somatic stress reactions (20,21). Previous studies have shown that a key cognitive distinction associated with anxiety is a "sense of uncontrollability focused on the possibility of future threat, danger or other potentially negative events" (22). In addition, IU has been hypothesized to prompt individuals to engage in over-identification of potential problems and negative orientations (14). ...
Objectives
A number of high school art students experience negative emotions during their preparation for the art college entrance examination, characterized by worries and fear of uncertainty. Therefore, how individual difference factors, such as intolerance of uncertainty, affect the negative emotions of students needs to be examined. Inspired by the integrative model of uncertainty tolerance, the current study seeks to explain the association between intolerance of uncertainty and negative emotions by testing the potential mediating role of psychological capital and the moderating role of family functioning.
Patients and methods
A total of 919 Chinese high school art students ( M age = 18.50 years, range = 16–22) participated from November 2022 to December 2022. Convenience sampling strategies were used. The participants were asked to complete the measures of intolerance of uncertainty scale, psychological capital questionnaire, depression anxiety stress scale, and family adaptability and cohesion evaluation scale. The data were analyzed using Pearson’s r correlations and moderated mediation analysis.
Results
Results showed that intolerance of uncertainty was positively associated with negative emotions but negatively associated with psychological capital, which in turn, was negatively associated with negative emotions. Psychological capital mediated the indirect link of intolerance of uncertainty with negative emotions. Family functioning buffered the impact of psychological capital on negative emotions.
Conclusion
This study can enhance our understanding of the intolerance of uncertainty on negative emotions and provide insights on interventions for high school art students’ negative emotions for educators. The interventions targeting intolerance of uncertainty, psychological capital and family functioning may be beneficial in reducing the effect of intolerance of uncertainty on negative emotions faced by high school art students.
... Anxiety disorders (AD) have become the most common type of mental disorder in the population, often leading to chronic illness and disability [1]. Anxiety disorders are characterized by excessive and persistent fear, anxiety, or avoidance of perceived threats, and may include panic attacks [2]. ...
Background
Anxiety disorders can cause serious physical and psychological damage, so many anxiety scales have been developed internationally to measure anxiety disorders, but due to the cultural differences and cultural dependence of quality of life between Chinese and Western cultures, it is difficult to reflect the main characteristics of Chinese patients. Therefore, we developed a scale suitable for Chinese patients with anxiety disorders: the Anxiety Disorders Scale of the Quality of Life Instruments for Chronic Diseases (QLICD-AD), hoping to achieve satisfactory QOL assessments for anxiety disorders.
Objectives
Items from the Anxiety Disorders Scale of the Quality of Life in Chronic Disease Instrument QLICD-AD system were analyzed using CTT and IRT to lay the groundwork for further refinement of the scale to accurately measure anxiety disorders.
Methods
120 patients with anxiety disorder were assessed using the QLICD-AD (V2.0). Descriptive statistics, variability method, correlation coefficient method, factor analysis and Cronbach’s coefficient of CTT, and graded response model (GRM) of item response theory were used to analyze the items of the scale.
Result
CTT analysis showed that the standard deviation of each item was between 0.928 and 1.466; Pearson correlation coefficients of item-to-domain were generally greater than 0.5 and also greater than that of item-to-other domain; the Cronbach ‘s of the total scale was 0.931, α of each domain was between 0.706 and 0.865. IRT analysis showed that the discrimination was between 1.14 and 1.44. The difficulty parameter of all items increased with the increase of grade. But some items (GPH6,GPH8,GPS3,GSO2-GSO4,AD2,AD5) difficulty parameters were less than 4 or greater than 4. The average of information amount was between 0.022 and 0.910.
Conclusion
Based on CTT and IRT analysis, most items of the QLICD-AD (V2.0) scale have good performance and good differentiation, but a few items still need further revision. Suggests that the QLICD-AD (V2.0) appears to be a valid measure of anxiety disorders. It may effectively improve the diagnosticity of anxiety disorders, but due to the limitations of the current sample, further validation is needed in a broader population extrapolation trial.
... Freud believed that anxiety is caused by a lack of security during childhood and adulthood. Research has shown that anxiety-related psychopathology seems to be associated with feelings of uncertainty and insecurity (Suarez et al., 2008). Anxiety is not produced in response to current, identifiable threats but rather in response to unresolved or potential threats that may or may not occur (Zhou et al., 2022). ...
The relationship between anxiety and sleep disorders is a key research topic in the academic community. However, evidence on the mechanism through which anxiety influences sleep disorders remains limited. The purpose of this study was to investigate the roles of flourishing and neuroticism in the mechanism through which anxiety influences sleep disorders in medical students. We constructed a moderated mediation model and tested the mediating role of flourishing and the moderating role of neuroticism in medical college students. The results showed that: (1) anxiety was significantly and positively related to sleep disorders and significantly and negatively related to flourishing; flourishing was significantly and negatively related to sleep disorders; neuroticism was significantly and positively related to sleep disorders; (2) flourishing had a mediation effect on the relationship between anxiety and sleep disorders; (3) neuroticism moderated the process through which flourishing mediated the effect of anxiety on sleep disorders. Our research expands the literature on the mechanism underlying the effects of anxiety on sleep disorders and provides insights into the potential prevention and intervention of sleep and emotional problems in medical students.
... Internalizing disorders, such as anxiety and depressive disorders, are the most commonly diagnosed mental illnesses [1]. They are highly comorbid due to shared vulnerabilities including genetic, temperamental, and psychological factors [2][3][4][5]. Despite their high prevalence rates and financial burden to society, many aspects of their phenomenology remain poorly understood. ...
Objective
Negative affect variability is associated with increased symptoms of internalizing psychopathology (i.e., depression, anxiety). The Contrast Avoidance Model (CAM) suggests that individuals with anxiety avoid negative emotional shifts by maintaining pathological worry. Recent evidence also suggests that the CAM can be applied to major depression and social phobia, both characterized by negative affect changes. Here, we compare negative affect variability between individuals with a variety of anxiety and depression diagnoses by measuring the levels and degree of change in the sentiment of their online communications.
Method
Participants were 1,853 individuals on Twitter who reported that they had been clinically diagnosed with an anxiety disorder (A cohort, n = 896) or a depressive disorder (D cohort, n = 957). Mean negative affect (NA) and negative affect variability were calculated using the Valence Aware Dictionary for Sentiment Reasoning (VADER), an accurate sentiment analysis tool that scores text in terms of its negative affect content.
Results
Findings showed differences in negative affect variability between the D and A cohort, with higher levels of NA variability in the D cohort than the A cohort, U = 367210, p < .001, r = 0.14, d = 0.25. Furthermore, we found that A and D cohorts had different average NA, with the D cohort showing higher NA overall, U = 377368, p < .001, r = 0.12, d = 0.21.
Limitations
Our sample is limited to individuals who disclosed their diagnoses online, which may involve bias due to self-selection and stigma. Our sentiment analysis of online text may not completely capture all nuances of individual affect.
Conclusions
Individuals with depression diagnoses showed a higher degree of negative affect variability compared to individuals with anxiety disorders. Our findings support the idea that negative affect variability can be measured using computational approaches on large-scale social media data and that social media data can be used to study naturally occurring mental health effects at scale.
... Stressful life events, however, have been shown to increase GAD relapse (Francis et al., 2012), thus, a stressful life-event such as the COVID-19 pandemic may be considered a risk factor for former GAD patients. Even after successful treatment, GAD, especially with an additional depressive predisposition, might represent a biological and psychological vulnerability (Suarez et al., 2009) and could be associated with a stronger, lasting impact of the pandemic. Alternatively, former patients might have benefited in a way from therapy that promotes resilience towards a stressful condition such as the pandemic. ...
Background: Research suggested that preexisting mental disorders, particularly generalized anxiety disorder (GAD), might increase the already elevated risk of responding to the COVID-19 pandemic with mental health impairments. The present follow-up study investigated the course of GAD symptoms during the pandemic in former outpatients (N = 86) of two randomized controlled trials who were treated with cognitive behavioral therapy (CBT) up to eight years ago. Methods: GAD symptomatology was examined as the probability for a “well month”, that is, a month with no or minimal symptoms, as assessed by the Longitudinal Interval Follow-Up Evaluation (LIFE), taking the periods pre-pandemic, early pandemic, lockdown, and post-lockdown into account, and considering depressive symptoms post-treatment as its predictor. Results: Generalized linear mixed models revealed lower odds ratios for a “well month” during the early pandemic period and higher odds ratios post-lockdown compared with pre-pandemic. Post-treatment depressive symptoms proved to be a significant predictor since pandemic onset. Strategies learned in CBT were analyzed for their applicability and helpfulness in coping with worries during the pandemic. Six particularly helpful strategies were identified by participants. Limitations: Although attrition was comparably low with no indication of an association between missingness and primary outcomes, bias cannot be ruled out. Conclusions: The findings provide preliminary support for the resilience of former CBT patients with GAD during COVID-19, for the long-term relevance of CBT strategies, and for post-treatment depressive symptoms as risk factors for exacerbation of GAD symptoms since the onset of the COVID-19 pandemic.
... (In)tolerance of uncertainty is another aversive response triggered by the perceived absence of information about a situation or experience (Carleton, 2012). It can generate feelings of anxiety and threat, particularly in relation to our perceived ability to cope and the possible consequences of an experience (Suárez et al., 2009), and is a universal experience of all organisms (Brosschot et al., 2016). Moreover, a perceived lack of control can amplify anxiety related to uncertainty (Carleton, 2012). ...
La psychologie au Canada est arrivée à une période critique. En 2018, la Société canadienne de psychologie et la Fondation de psychologie du Canada ont reconnu qu’elles avaient enfreint leur propre code de déontologie dans leur traitement des peuples autochtones du pays et ont formulé de multiples recommandations en vue de reconnaître leur responsabilité pour le tort fait et de travailler en vue à la (ré)conciliation. La violence coloniale et l’oppression persistent au Canada, et il faut des mesures concrètes pour intégrer ces recommandations dans notre travail de psychologues, peu importe notre domaine de spécialisation ou notre carrière. Toutefois, nombreux sont les psychologues qui, ne sachant pas où commencer ou craignant faire un faux pas, s’abstiennent de prendre action. Dans cet article, nous conceptualisons cet évitement en tant que réaction prévisible face à l’inconnu et à l’incertitude. La maîtrise de ces réactions et la poursuite de la (ré)conciliation constituent une responsabilité éthique pour les psychologues. Nous fournissons des recommandations concrètes sur la façon dont les psychologues peuvent entamer le chemin vers la (ré)conciliation, afin de travailler à la décolonisation et à l’«autochtonisation» de la psychologie. Ces recommandations incluent : définir sonpositionnement, pratiquer l’introspection, connaître son espace, pratiquer l’inclusion et favoriser les bonnes relations, adopter une souplesse psychologique et les diverses formes de l’action engagée, en commençant dans sapropre sphère d’influence. Les psychologues ont une influence sur les Canadiens et les Canadiennes en raison de la diversité de leurs rôles (enseignants, praticiens, chercheurs, fonctionnaires, décisionnaires …). Ainsi, choisir la voie de la (ré)conciliation en tant que psychologues peut avoir d’importantes répercussions sur la société canadienne.
... The general psychological vulnerability pertains to stable, established beliefs regarding perceived control over stressful life circumstances and emotional states, which develop during early childhood in response to a challenging, unstable environment and problematic parenting styles (Barlow, 2004). If an individual is subject to both forms of general vulnerabilities, they are considered to be at increased risk for development of an emotional disorder after a stressful life event (Suárez et al., 2009). Disorder-specific vulnerabilities pertain to the sources of distress that develop in response to learning experiences that certain stimuli or experiences lead to uncomfortable negative emotional states. ...
Psychiatric comorbidities are common throughout clinical practice. This article discusses the prevalence and etiology of psychiatric comorbidities, in addition to commenting on clinical implications and future directions. Modern comorbidity research frequently evaluates whether psychiatric comorbidity reflects the presence of two or more distinct conditions, or different manifestations of an underlying/overarching form of psychopathology. While the field has often relied upon categorical approaches to psychiatric comorbidities, a dimensional approach to diagnosing psychiatric disorders has the potential to address criticisms of the categorical approach, aid clinicians in working with complex clinical presentations, and present novel opportunities for future comorbidity research.
... One such intervention is the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; , which targets common mechanisms associated with emotional disorders. Core psychological vulnerabilities such as emotion avoidance and deficits in emotion regulation are proposed to underlie symptomatology across a number of emotional disorders (Sheppes et al., 2015;Suárez et al., 2009). Indeed, there is evidence that the experience and avoidance of negative affect accounts for much of the shared variance of common psychiatric disorders (T. Brown et al., 1998). ...
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is an intervention that targets common mechanisms that maintain symptoms across multiple disorders. The UP has been shown to be effective across many disorders, including generalized anxiety disorder, major depressive episode (MDE), and panic disorder, that commonly codevelop following trauma exposure. The present study represented the first randomized controlled trial of the UP in the treatment of trauma‐related psychopathology, including posttraumatic stress disorder (PTSD), depression, and anxiety symptoms. Adults (N = 43) who developed posttraumatic psychopathology that included PTSD, MDE, or an anxiety disorder after sustaining a severe injury were randomly assigned to receive 10–14 weekly, 60‐min sessions of UP (n = 22) or usual care (n = 21). The primary treatment outcome was PTSD symptom severity, with secondary outcomes of depression and anxiety symptom severity and loss of diagnosis for any trauma‐related psychiatric disorder. Assessments were conducted at intake, posttreatment, and 6‐month follow‐up. Posttreatment, participants who received the UP showed significantly larger reductions in PTSD, Hedges’ g = 1.27; anxiety, Hedges’ g = 1.20; and depression symptom severity, Hedges’ g = 1.40, compared to those receiving usual care. These treatment effects were maintained at 6‐month follow‐up for PTSD, anxiety, and depressive symptom severity. Statistically significant posttreatment loss of PTSD, MDE, and agoraphobia diagnoses was observed for participants who received the UP but not usual care. This study provides preliminary evidence that the UP may be an effective non–trauma‐focused treatment for PTSD and other trauma‐related psychopathology.
... In spite of the fact that some studies that have found signifi cant changes both in the reduction of negative affect and in the increase of positive affect (Farchione et al., 2012;Osma, Castellano, Crespo, & García-Palacios, 2015), in the study of Bullis, Fortune, Farchione, and Barlow (2014), a signifi cant long-term (6 months) change was found in the decrease of negative affect (ESsg = 1.00) and a not very signifi cant change in the increase of positive affect (ESsg = -.53). These data show, on the one hand, that the UP positively infl uenced the variable of generalized biological vulnerability (Suárez, Bennett, Goldstein, & Barlow, 2009), corroborating the malleability of negative affect over time and with adequate treatment . On the other hand, regarding positive affect, the results could also be explained by Jordi's lack of practice in some emotion regulation strategies that could have benefi tted him more in the increase of positive affect, for example, focusing on the present moment or exposing himself emotionally to different social activities. ...
... Two of the most prominent diatheses are neuroticism (NT) and extraversion or positive temperament (PT) (Fanous, Gardner, Prescott, Cancro, & Kendler, 2002;Hettema, Prescott, & Kendler, 2004;Viken, Rose, Kaprio, & Koskenvuo, 1994). These dimensions are considered components of a general biological vulnerability for emotional disorders, which includes stable and genetically based dispositions to experience negative emotions (Barlow, 2000;Suárez, Bennett, Goldstein, & Barlow, 2009). NT is associated with mood and anxiety disorders to varying degrees, with generalized anxiety disorder (GAD) and depression having the strongest association, and specific phobia the weakest (Brown, 2007;Brown, Chorpita, & Barlow, 1998;Mineka, Watson, & Clark, 1998;Watson, Gamez, & Simms, 2005). ...
Using a factor mixture model (FMM) approach, we examined whether social anxiety disorder (SAD) could be subtyped by distinct risk profiles and whether these subtypes predicted different manifestations of the disorder. We derived risk profiles from neurotic temperament (NT), positive temperament (PT), and autonomic arousability (AA), which are hypothesized to be important in the maintenance of anxiety disorders such as SAD. In our sample of 758 SAD outpatients, a two-class FMM solution fit the data best. Class 1 was characterized by very low PT, whereas PT in Class 2 was substantially higher. The two classes differed to a lesser extent on NT but were virtually equivalent on AA. Class 1 had significantly more men and individuals with depressive disorders, generalized SAD, and higher SAD severity. Class 2 had more individuals with performance subtype SAD. These findings provide initial support for distinct risk profiles within SAD that may be predictive of its clinical expression.
... Indeed, a general tendency to avoid situations that elicit emotional distress is a risk factor for functional impairment and low quality of life across a range of other diagnostic categories, such as obsessive-compulsive disorder, (e.g., Kashdan et al. 2006), whereas willingness to approach such situations is linked with resiliency in the face of psychological distress (e.g., Kashdan and Kane 2011). In this way, the present findings are consistent with theoretical models of BDD that posit that BDD shares features-including, potentially, underlying maintenance processes-with other obsessive compulsive and anxiety-related disorders, further indicating that shared psychological vulnerabilities might underpin these similar disorders (Phillips 2015;Suárez et al. 2009). ...
Individuals with body dysmorphic disorder (BDD) experience elevated social avoidance, both as a consequence and independent of BDD concerns. To explore how social avoidance relates to the long-term course of functioning for people with BDD, this prospective longitudinal study evaluated the hypothesis that initial social avoidance would predict changes in psychosocial functioning over 3 years, such that greater initial social avoidance would predict worsening functioning. At intake, individuals with BDD (N = 200) completed measures of social avoidance independent of BDD, social avoidance due to BDD or any other source, overall psychosocial functioning, and psychosocial functioning in specific domains. Overall and specific functioning was prospectively evaluated at three subsequent yearly follow-up assessments. Mixed model analyses evaluated the relation between baseline social avoidance and changes in functioning. Results provided mixed support for hypotheses, indicating that higher baseline social avoidance independent of BDD predicted worsening functioning in two of the four overall functioning indices and in both specific domains—interpersonal relationship quality and work/academic/household functioning. Higher global social avoidance (due to BDD or any other source) predicted poorer overall functioning for two of the four global functioning indices but did not predict functioning in either specific domain. Social avoidance, both related and unrelated to body image, might play an important role in the trajectory of psychosocial functioning for people with BDD.
... Along with the genetic factors [5,6,7,8] the environmental factors like stress and pressures etc. [9,10,11,12,13] have been found to be responsible for the anxiety. The psychological factors include learnt patterns of behavior through conditioning, imitation etc. [14,15]. Overprotection at home can also lead to the development of anxiety disorder [14,16,17,18,19]. ...
Anxiety is a continuous fear of something bad that may happen. It is one of the common problems. Modernization and urbanization along with the nuclearisation of the family system has lead to an increase the anxiety among everybody especially the youth. The emerging youth are the future of the nation and play a vital role in its development. This is the stage which is neither childhood nor adulthood, is apprehensive of the future and has tendency to develop many fears of the unknown. In India there are very less number of psychotherapists available and lot of people with psychological problems like anxiety do not have access to such services. There is a need of short therapy which can help people solve their problems in short time. This paper attempts to summarize the results of research conducted to see the effect of a short therapy like SFBT on anxiety among the emerging youth. The study was designed with an experimental and control group. 5 participants with mild to moderate anxiety received the solution focused therapy and 5 participants with mild to moderate anxiety were re-administered the anxiety inventory after a gap of about one month. The measuring tool for anxiety used for the study was Beck’s Anxiety Inventory. The statistical analysis included t-test of independent sample and repeated measure ANOVA.
... These disorders are classified into three broad domains (anxiety disorders, trauma-and stressor-related disorders, obsessive-compulsive and related disorders; Diagnostic and Statistical Manual of Mental Disorders [5th ed.; ; American Psychiatric Association [APA], 2013) depending on the nature of the behavioural changes, physical difficulties and cognitive manifestations which accompany the excessive anxiety and fear. While they have distinctive features, there is good evidence that these disorders have common vulnerabilities and share underlying pathological processes which explain how the maladaptive regulation of anxiety and fear develops and is maintained (Barlow, 2002;Brown et al., 2001;Suarez et al., 2009). Cognitive-behavioural therapy (CBT) attempts to alter these underlying maintenance processes and reduce the ongoing influence of the vulnerabilities. ...
Objective:
This review examines the evidence from head-to-head randomised controlled trials addressing whether the efficacy of cognitive-behavioural therapy for anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorders in adults delivered by computer or online (computer- and Internet-delivered cognitive-behavioural therapy) is not inferior to in-person cognitive-behavioural therapy for reducing levels of symptoms and producing clinically significant gains at post-treatment and at follow-up. A supplementary aim is to examine the evidence for severity as a moderator of the relative efficacy of computer- and Internet-delivered cognitive-behavioural therapy and in-person cognitive-behavioural therapy.
Method:
PubMed, PsycINFO, Embase and Cochrane database of randomised trials were searched for randomised controlled trials of cognitive-behavioural therapy for these disorders with at least an in-person cognitive-behavioural therapy and Internet or computer cognitive-behavioural therapy arm.
Results:
A total of 14 randomised controlled trials (9 Internet, 5 computer) of cognitive-behavioural therapy for social anxiety disorder, panic disorder and specific phobia and 3 reports of effect moderators were included. One study showed a low risk of bias when assessed against risk of bias criteria for non-inferiority trials. The remaining studies were assessed as high or unclear risk of bias. One study found that Internet-delivered cognitive-behavioural therapy was superior and non-inferior at post-treatment and follow-up to group in-person cognitive-behavioural therapy for social anxiety disorder. One study of Internet-delivered cognitive-behavioural therapy for panic disorder showed non-inferiority to individual in-person cognitive-behavioural therapy for responder status at post-treatment and one of Internet cognitive-behavioural therapy for panic disorder for symptom severity at follow-up. Other comparisons (22 Internet, 13 computer) and for estimates pooled for Internet cognitive-behavioural therapy for social anxiety disorder, Internet cognitive-behavioural therapy for panic disorder and computer-delivered cognitive-behavioural therapy studies did not support non-inferiority. Evidence of effect moderation by severity and co-morbidity was mixed.
Conclusion:
There is limited evidence from randomised controlled trials which supports claims that computer- or Internet-delivered cognitive-behavioural therapy for anxiety disorders is not inferior to in-person delivery. Randomised controlled trials properly designed to test non-inferiority are needed before conclusions about the relative benefits of in-person and Internet- and computer-delivered cognitive-behavioural therapy can be made.
Prospero:
CRD420180961655-6.
... In spite of the fact that some studies that have found signifi cant changes both in the reduction of negative affect and in the increase of positive affect (Farchione et al., 2012;Osma, Castellano, Crespo, & García-Palacios, 2015), in the study of Bullis, Fortune, Farchione, and Barlow (2014), a signifi cant long-term (6 months) change was found in the decrease of negative affect (ESsg = 1.00) and a not very signifi cant change in the increase of positive affect (ESsg = -.53). These data show, on the one hand, that the UP positively infl uenced the variable of generalized biological vulnerability (Suárez, Bennett, Goldstein, & Barlow, 2009), corroborating the malleability of negative affect over time and with adequate treatment . On the other hand, regarding positive affect, the results could also be explained by Jordi's lack of practice in some emotion regulation strategies that could have benefi tted him more in the increase of positive affect, for example, focusing on the present moment or exposing himself emotionally to different social activities. ...
Background: The study presents the use of the Unified Protocol (UP) in a case of a male diagnosed with major depressive disorder and schizoid and depressive personality traits. The therapeutic focus of UP is to identify maladaptive behaviors of emotion regulation and to train new regulation strategies such as cognitive re-appraisal or emotional exposure exercises.
Method: This is a single-case research study. The intervention was carried out in twenty 1-hour sessions for 6 months. After treatment completion, follow-ups were conducted at three, six, and twelve months.
Results: The results of the 12-month follow-up revealed a clinically significant change in
depressive symptomatology (RCI BDI-II = -5.51), negative affect (RCI NEGATIVE PANAS = -3.61), quality of life (RCI ICV-Sp = 4.61) and schizoid (RCI MCMIIII- Schizoid = -4.36) and depressive (RCI MCMI-III-Depressive = -5.24) personality traits. Schizoid and depressive personality traits did not interfere with the application, course, and compliance with treatment. These results are discussed with regard to similar studies, also based on the use of the UP to work on emotion regulation in the treatment of emotional disorders
with clinical comorbidity.
Conclusions: The training of emotion regulation strategies through UP could be an effective proposal to treat emotional disorders with pathological personality traits comorbidity.
... The Unified Protocol (UP) for the Treatment of Emotional Disorders [8,9] is a recently developed form of cognitive behavioral therapy (CBT).The UP can be applied to a variety of disorders simultaneously and it can be easily performed in a group format. The UP was created on the basis of the identification of common psychopathological vulnerability factors in EDs [1,10].In the UP, traditional CBT techniques (i.e., cognitive restructuring) are combined with more novel psychological skills (i.e., increasing awareness) to treat emotion regulation deficits, which are argued to be the underlying common factors in all EDs [11]. The UP is a structured, manual-based treatment [8,9] which facilitates group delivery when patients present different EDs [11]. ...
Background
Emotional disorders, which include both anxiety and depressive disorders, are the most prevalent psychological disorders according to recent epidemiological studies. Consequently, public costs associated with their treatment have become a matter of concern for public health systems, which face long waiting lists. Because of their high prevalence in the population, finding an effective treatment for emotional disorders has become a key goal of today’s clinical psychology. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders might serve the aforementioned purpose, as it can be applied to a variety of disorders simultaneously and it can be easily performed in a group format.
Methods
The study is a multicenter, randomized, non-inferiority controlled clinical trial. Participants will be 220 individuals with emotional disorders, who are randomized to either a treatment as usual (individual cognitive behavioral therapy) or to a Unified Protocol condition in group format. Depression, anxiety, and diagnostic criteria are the primary outcome measures. Secondary measures include the assessment of positive and negative affect, anxiety control, personality traits, overall adjustment, and quality of life. An analysis of treatment satisfaction is also conducted. Assessment points include baseline, post-treatment, and three follow-ups at 3, 6, and 12 months. To control for missing data and possible biases, intention-to-treat and per-protocol analyses will be performed.
Discussion
This is the first randomized, controlled clinical trial to test the effectiveness of a transdiagnostic intervention in a group format for the treatment of emotional disorders in public settings in Spain. Results obtained from this study may have important clinical, social, and economic implications for public mental health settings in Spain.
Trial registration
Retrospectively registered at https://clinicaltrials.gov/. Trial NCT03064477 (March 10, 2017). The trial is active and recruitment is ongoing. Recruitment is expected to finish by January 2020.
... Uncertainty is the inability to determine a situation's outcome or to predict the valence, intensity, likelihood, or type of future stimulus (Carleton, 2012). Anticipating uncertain potential threat and adjusting cognitively (e.g., planning a means of response) and physiologically (e.g., fight or flight response) can be beneficial for the individual, especially when the threat is imminent and likely to occur (Barlow, 2002;Su arez, Bennett, Goldstein, & Barlow, 2009). In contrast, extreme anxiety is thought to be developed and maintained by excessive anticipatory processes in the face of uncertainty (Grupe & Nitschke, 2013). ...
Uncertainty is often associated with subjective distress and a potentiated anxiety response. Occurrence uncertainty, or the inability to predict if a threat will occur, has rarely been compared experimentally with temporal uncertainty, or the inability to predict when a threat will occur. The current study aimed to (a) directly compare the anxiogenic effects of anticipating these two types of uncertain threat, as indexed by the eyeblink startle response, and (b) assess the relationship between startle response to occurrence and temporal uncertainty and individual differences in self-reported intolerance of uncertainty and anxiety. The findings indicated that anticipation during occurrence uncertainty elicited a larger startle response than anticipating a certain threat, but anticipation during temporal uncertainty was superior at potentiating startle blink overall. Additional analyses of the effects of order and habituation further highlighted temporal uncertainty's superiority in eliciting greater startle responding. This suggests that, while uncertainty is physiologically anxiety provoking, some level of certainty that the threat will occur enhances the robustness of the physiological anxiety response. However, self-reported anxiety was equivalent for temporal and occurrence uncertainty, suggesting that, while defensive responding may be more affected by temporal uncertainty, people perceive both types of uncertainty as anxiogenic. Individual differences in the intolerance of uncertainty and other anxiety measures were not related to anticipatory startle responsivity during any of the conditions.
... A review of interoception in mental disorders found a strong association between panic attacks and visceral symptoms, and that clients with anxiety disorders demonstrate more cardiac and gastrointestinal awareness than nonanxious controls (Scarella, Laferton, Ahern, Fallon, & Barsky, 2016). Some etiological models of anxiety disorders (e.g., the triple vulnerability framework) suggest that certain experiences of learning about danger to oneself during development may elicit heightened vulnerability to anxiety disorders (Suarez, Bennett, Goldstein, & Barlow, 2008). ...
Objective:
Maladaptive repetitive thought (RT), the frequent and repetitive revisiting of thoughts or internal experiences, is associated with a range of psychopathological processes and disorders. We present a synthesis of prior research on maladaptive RT and develop a framework for elucidating and distinguishing between five forms of maladaptive RT.
Method:
In addition to the previously studied maladaptive RT (worry, rumination, and obsession), this framework is used to identify two additional forms of maladaptive RT (yearning and interoceptive RT). We then present a review of extant psychotherapy intervention research targeting maladaptive RT, focusing both on specific empirically based treatment strategies, and also constructs within treatments that impact maladaptive RT.
Conclusion:
The paper concludes with recommendations for future basic and intervention research on maladaptive RT and related psychopathologies.
... 69). In more recent work, Barlow has proposed that similar processes as those producing panic disorder also produce social phobia (Barlow, 1988(Barlow, , 2002Suárez, Bennett, Goldstein, & Barlow, 2008). Barlow, Allen, and Basden (2007) review evidence for this theory. ...
This commentary explores reasons why one client’s outcome was better than the other’s in two comparative case studies: the cases of "Maria" and "Andrea,” involving panic disorder (Ciuca, Berger, & Miclea, 2017); and the cases of "Daydreamer" and "Night Owl," involving social anxiety (Schulz, Vincent, & Berger, 2017). Findings suggest that both specific and common factors may explain the difference. Specific factors include the extent to which exteroceptive exposure was implemented and avoidant behaviors were relaxed. Common factors that may explain the difference in outcome include acceptance of the treatment model, number of success experiences, perceived self-efficacy, and the logical link between the client’s explanation of problems and the treatment offered.
... As in all other parts of the program, references and suggestions for further information are provided. (3)Anxiety module: The anxiety module is broadly consistent with contemporary CBT and transdiagnostic approaches to anxiety [63][64][65], which have already been shown by our group to be effective when delivered via an Internet intervention [48]. Interactive sequences are used to explain the nature and function of anxiety, emphasizing the idea that anxiety can serve a useful function (e.g., signaling potential danger) but can be unhelpful when it is automatically triggered easily in the absence of actual danger (i.e., "false alarm" model). ...
Background:
Depression is common among persons with epilepsy (PwE), affecting roughly one in three individuals, and its presence is associated with personal suffering, impaired quality of life, and worse prognosis. Despite the availability of effective treatments, depression is often overlooked and treated inadequately in PwE, in part because of assumed concerns over drug interactions or proconvulsant effects of antidepressants. Internet-administered psychological interventions might complement antidepressant medication or psychotherapy, and preliminary evidence suggests that they can be effective. However, no trial has yet examined whether an Internet intervention designed to meet the needs of PwE can achieve sustained reductions in depression and related symptoms, such as anxiety, when offered as adjunct to treatment as usual.
Methods/design:
This randomized controlled trial will include 200 participants with epilepsy and a current depressive disorder, along with currently at least moderately elevated depression (Patient Health Questionnaire (PHQ-9) sum score of at least 10). Patients will be recruited via epilepsy treatment centers and other sources, including Internet forums, newspaper articles, flyers, posters, and media articles or advertisements, in German-speaking countries. Main inclusion criteria are: self-reported diagnosis of epilepsy and a depressive disorder, as assessed with a phone-administered structured diagnostic interview, none or stable antidepressant medication, no current psychotherapy, no other major psychiatric disorder, no acute suicidality. Participants will be randomly assigned to either (1) a care-as-usual/waitlist (CAU/WL) control group, in which they receive CAU and are given access to the Internet intervention after 3 months (that is, a CAU/WL control group), or (2) a treatment group that may also use CAU and in addition immediately receives six-month access to the novel, Internet-administered intervention. The primary outcome measure is the PHQ-9, collected at three months post-baseline; secondary measures include self-reported anxiety, work and social adjustment, epilepsy symptoms (including seizure frequency and severity), medication adherence, potential negative treatment effects and health-related quality of life. Measurements are collected online at pre-treatment (T0), three months (T1), six months (T2), and nine months (T3).
Discussion:
Results of this trial are expected to extend the body of knowledge with regard to effective and efficient treatment options for PwE who experience elevated depression and anxiety.
Trial registration:
ClinicalTrials.gov: NCT02791724 . Registered 01 June 2016.
... Goodman and Gotlib's (1999) developmental model of the transmission of depression identified several contributory factors, including heritability, dysfunctional neuroregulatory mechanisms, exposure to negative maternal cognitions and behaviors, and the stressful context of children's lives (e.g., high levels of marital conflict). Barlow (2002) has also advanced a "triple vulnerability" etiological model of emotional disorders in which generalized biological (e.g., a genetic predisposition to being "high-strung," behaviorally inhibited, nervous), nonspecific psychological (e.g., diminished sense of control, low self-esteem), and specific psychological vulnerabilities (i.e., experiencing a real danger, false alarm, or vicarious exposure) operate interactively to increase risk (see Suárez, Bennett, Goldstein, & Barlow, 2008). Parental control and experiences with uncontrollability are hypothesized to interfere with the development of autonomy, self-efficacy, and acquisition of effective problem-solving skills in youth that, in turn, render them more vulnerable to dealing unsuccessfully with stress, and later depression and anxiety. ...
... Second, metacognitions comprise thoughts about thinking, especially the role of positive and negative beliefs about worry (Wells 1995(Wells , 2011. The third is threat appraisal, which can be broadly defined in terms of cognitive processing of threat related cues, including perceived likelihood of threat, the associated cost of harm, and coping ability (Beck et al. 1985;Cartwright-Hatton et al. 2003;Clark and Beck 2011;Dugas et al. 1995;Mathews and Macleod 1994;Papworth et al. 2013;Rusting 1998;Wells 1995;Suárez et al. 2009). Research into the role of intolerance of uncertainty and the role of metacognition in child and adolescent generalized anxiety has benefited considerably from the development of self-report measures of these processes (Bacow et al. 2009;Comer et al. 2009). ...
Despite the emphasis on threat appraisal in cognitive models of anxiety, self-report measures of related processes in children and adolescents have been lacking. This paper reports on the development and preliminary psychometric evaluation of a new measure of threat appraisal for children and adolescents – the Threat Appraisal Questionnaire for Children (TAQ-C). Based on current conceptualisations of threat appraisal, the TAQ-C was designed to index the construct across three dimensions: probability, cost, and coping difficulties. Confirmatory Factor Analysis was used to examine this structure in a community sample of n = 312 children (ages 9–15 years, 55% female). Results indicated that the scores on the instrument capture three factors (Probability, Cost and Coping difficulties). Moreover, a model in which the 1st-order factors loaded significantly on a single 2nd order factor of threat in general, was supported. The TAQ-C was found to demonstrate good internal consistency, and acceptable levels of test-retest reliability within a 3–4 week interval, when evaluated with a subsample of n = 51 children. Support for convergent validity was demonstrated, with TAQ-C scores found to correlate strongly with existing measures of child anxiety, and conceptually related cognitive processes. Divergent validity was also evidenced, with low correlations found between TAQ-C scores and the unrelated construct measure of Hyperactivity-Inattention. The TAQ-C, therefore, appears to be a promising measure with a range of potential applications for child and adolescent settings.
... More importantly, research findings demonstrate substantial commonalities among emotional disorders (Wilamowska et al., 2010). These findings led Barlow (1991, Suarez, Bennett, Goldstein, & Barlow, 2009) to propose the unification of emotional disorders as a transdiagnostic syndrome. From this point of view, the self-wounds model can be easily applied to other emotional disorders. ...
The self-wounds model of anxiety disorders based on the work of Wolfe (2005, 2006) is delineated here. The focal point of this model is the concept of wounded self or early unresolved emotional injuries. According to this view, anxiety disorders represent a chronic struggle with painful experiences. These emotional experiences are driven by two interrelated layers of psychological processes which arise from the wounded self. While the first layer of this process entails conscious awareness of symptoms resulting from cognitive distortions, the second layer comprises implicit or unconscious interpretations of what the symptoms mean to the patient. This article describes the components of the self-wounds model of anxiety disorders, which offers an integrative perspective on the development, onset, maintenance, and treatment of anxiety disorders. This model can be easily adapted to the understanding and treatment of other emotional disorders.
... The associations between lack of control over external events and psychological distress have been extensively reviewed elsewhere (e.g., Chorpita and Barlow, 1998;Forgeard et al., 2011). For example, research suggests that early experience of loss of control contributes to anxiety/depression (Chorpita and Barlow, 1998;Suárez et al., 2009). Perceived loss of control of teenagers and adolescents has been shown to mediate the relationship between family environment (e.g., communication, behavioral control) and anxiety (Ballash et al., 2006;McLeod et al., 2007;Nanda et al., 2012). ...
Background: Increasingly, research supports the utility of a transdiagnostic understanding of psychopathology. However, there is no consensus regarding the theoretical approach that best explains this. Transdiagnostic interventions can offer service delivery advantages; this is explored in the current review, focusing on group modalities and primary care settings.
Objective: This review seeks to explore whether a Perceptual Control Theory (PCT) explanation of psychopathology across disorders is a valid one. Further, this review illustrates the process of developing a novel transdiagnostic intervention (Take Control Course; TCC) from a PCT theory of functioning.
Method: Narrative review.
Results and Conclusions: Considerable evidence supports key tenets of PCT. Further, PCT offers a novel perspective regarding the mechanisms by which a number of familiar techniques, such as exposure and awareness, are effective. However, additional research is required to directly test the relative contribution of some PCT mechanisms predicted to underlie psychopathology. Directions for future research are considered.
... The triple-vulnerability model of etiology (Barlow, 2000;Su arez, Bennett, Goldstein, & Barlow, 2009) suggests that an interacting set of vulnerabilities confers risk for developing an emotional disorder. These vulnerabilities are a generalized biological vulnerability (i.e., a genetic vulnerability to the expression of emotional disorders), a generalized psychological vulnerability (i.e., a diminished sense of control emerging out of early life experiences), and specific psychological vulnerabilities (i.e., factors that contribute to the development of specific DSM disorders and are also often a result of early learning experiences). ...
Anger plays a prominent definitional role in some psychological disorders currently widely scattered across DSM-5 categories (e.g., intermittent explosive disorder, borderline personality disorder). But the presence and consequences of anger in the emotional disorders (e.g., anxiety disorders, depressive disorders) remain sparsely examined. In this review, we examine the presence of anger in the emotional disorders and find that anger is elevated across these disorders and, when it is present, is associated with negative consequences, including greater symptom severity and worse treatment response. Based on this evidence, anger appears to be an important and understudied emotion in the development, maintenance, and treatment of emotional disorders.
Background and Aim: Adolescence is a period of profound changes that separates a child from an adult, and considerable changes take place in the concept of self. The purpose of this research was to determine the effectiveness of group therapy based on emotion regulation training on strengthening adolescent identity base and increasing family relationships on adolescent girls in Isfahan city. Methods: The research method was semi-experimental with a pre-test-post-test design and a three-month follow-up with the experimental and control groups. The statistical population of all girls aged 15 to 18, studying in secondary schools, about 40 people were selected by available sampling method and were randomly divided into two groups of 20 people, experimental and control. The research tools included the identity questionnaire of Benyon and Adams (1986) and family relationships (Ritchie & Fitzpatrick, 1990), which were completed in three stages: pre-test, post-test and follow-up by both groups. Barlow's Emotion Regulation Training Program (Allen, McHugh & Barlow, 2009). It was conducted in 12 weekly sessions of 90 minutes for the experimental group. The data were analyzed with the help of descriptive statistics (mean and standard deviation) and inferential statistics (variance analysis with repeated measures). Results: The results of the research showed that there is a significant difference between the average scores of the dimensions of identity behaviors (postponed identity, confused identity, early formed identity and advanced identity) and family relationships (dialogue orientation and conformity orientation) in the two stages of pre-test and post-test. Conclusion: The results showed that education based on emotion regulation had a significant and positive effect on increasing the score of the identity database and family relationships. The follow-up phase also remained stable.
Leader self-serving behavior has been associated with a range of adverse outcomes in the workplace. However, much remains to be explored about why and when such leader behavior emerges in organizations. This research develops and tests a theoretical framework that delineates the emotional and cognitive states that give rise to leader self-serving behavior. Specifically, we draw on uncertainty management theory to theorize that job insecurity heightens leaders' anxiety and self-serving cognitions that subsequently trigger leader self-serving behavior. We further argue that the overall justice of an organization effectively mitigates the indirect relationship between a leader's sense of job insecurity and leader self-serving behavior via leader anxiety and self-serving cognitions. Results from a three-wave field study involving 481 leader-follower dyads provide support for our hypothesized model. We discuss the implications of our findings for leadership theory and practice. K E Y W O R D S anxiety, leader job insecurity, leader self-serving behavior, overall justice, self-serving cognitions
The aim of the present study was to provide evidence on the preliminary clinical usefulness and treatment satisfac-tion with the Unified Protocol (UP) designed by Barlow et al. (2011), applied in group and online format in adults with emotional disorders in Argentina. To this end, a non-controlled study was conducted with pre-and post-treat-ment measurements. The group included seven participants with symptoms belonging to the anxiety-depression spectrum. The intervention consisted of 11 weekly 90-mi-nute synchronic meetings held on an online platform. The results showed a significant reduction in participants’ lev-els of depression, hopelessness, emotional regulation dif-ficulties, and negative affect, as well as a significant in-crease in their quality of life. In turn, large effect sizes were found for depression, anxiety, hopelessness, emo-tional regulation difficulties, and negative affect. The pre-liminary findings in this study are promising as regards the UP’s clinical usefulness and utilization acceptability in online group format for Argentina’s population.
The aim of the present study was to provide evidence on the preliminary clinical usefulness and treatment satisfaction with the Unified Protocol (UP) designed by Barlow et al. (2011), applied in group and online format in adults with emotional disorders in Argentina. To this end, a noncontrolled study was conducted with pre- and post-treatment measurements. The group included seven pants with symptoms belonging to the anxiety-depression participants spectrum. The intervention consisted of 11 weekly 90-minute synchronic meetings held on an online platform. The results showed a significant reduction in participants’ levels of depression, hopelessness, emotional regulation difficulties, and negative affect, as well as a significant increase
in their quality of life. In turn, large effect sizes were found for depression, anxiety, hopelessness, emotional regulation difficulties, and negative affect. The preliminary
findings in this study are promising as regards the UP’s clinical usefulness and utilization acceptability in online group format for Argentina’s population.
The transition from undergraduate study to a postgraduate career can be an anxiety provoking experience for many students. In this study, we explore the shared experience of five ‘anxious’ undergraduate students as they transition from higher education towards their postgraduate careers. Using a qualitative methodology, semi-structured interviews were conducted with five female undergraduate students from different courses at a UK university. A thematic analysis revealed two overarching themes: perceived pressure without sufficient support, and concerns about next steps. The findings suggested that the final year is emotionally demanding, and students felt as though there was a lack of provision to manage their transition to postgraduate work or study. Possible implications for policymakers are detailed and areas of research discussed.
Anxious reactions can range from mild to severe. Anxiety disorders occur when anxiety becomes so severe that it interrupts and/or disrupts the child's ability to function. This chapter gives an overview of anxiety in children and adolescents, focusing on normal development, epidemiology, theories of etiology, and the types of anxiety disorders that children and adolescents present when seen in pediatric primary care. It is challenging for advanced practice registered nurses (APRNs) to differentiate anxiety that is a normal part of development from that which has the potential to disrupt functioning. Comorbid conditions and evidence‐based assessments and interventions are presented, along with the role differentiation between APRNs focused on psychiatric treatment versus those focused on primary care management. Implications for advanced nursing practice, education, and research are discussed.
Anxiety disorders are among the most common psychiatric disorders in children and adolescents. As reviewed in this guideline, both cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication have considerable empirical support as safe and effective short-term treatments for anxiety in children and adolescents. Serotonin norepinephrine reuptake inhibitor (SNRI) medication has some empirical support as an additional treatment option. In the context of a protracted severe shortage of child and adolescent-trained behavioral health specialists, research demonstrating convenient, efficient, cost-effective, and user-friendly delivery mechanisms for safe and effective treatments for child and adolescent anxiety disorders is an urgent priority. The comparative effectiveness of anxiety treatments, delineation of mediators and moderators of effective anxiety treatments, long-term effects of SSRI and SNRI use in children and adolescents, and additional evaluation of the degree of suicide risk associated with SSRIs and SNRIs, remain other key research needs.
Students on the autism spectrum who exhibit sexually problematic behaviors in a public school setting are often misunderstood, and over time lead restrictive, isolated, and lonely lives removed from their peers. How can we best address sexually problematic behaviors with students on the spectrum, while upholding the lesser restrictive tenets revered by public education? Unfortunately, without fully understanding the significance their anomalous behaviors serve, students on the spectrum are typically fast-tracked to out-of-district placements. The purpose of this chapter is to present a case study that illuminates the complexities of addressing autism, sexuality, and education in a public school setting. This case will provide a summary of the assessment and programmatic design process, using targeted and evidenced-informed interventions specific to autism. Finally, this case will stress the importance of interdisciplinary collaboration, including parent partnership for promoting positive outcomes within the less restrictive environment.
We describe a transdiagnostic treatment for anxiety disorders in community mental health centers (CMHCs), based on the Unified Protocol (Barlow et al. 2011), and adapted to a group format (UP-G). Participants were 13 CMHC patients in an intensive measurement design. Participants were interviewed for anxiety severity at pre- and post-treatment and completed weekly self-reports of distress, emotion dysregulation, valued living, fear of bodily sensations, and therapeutic alliance. We observed significant improvements in all measures except for valued living. Improvements in emotion regulation preceded and predicted subsequent reductions in distress as well as the other way around. Improvements in alliance co-occurred with reductions in distress. The UP-G is a flexible intervention that is suitable for CMHCs and may assist in reducing the burden of anxiety disorders and improving dissemination. These preliminary findings suggest that improvements in emotion regulation may play an important role in facilitating change in the UP-G.
Episodic Future Thinking (EFT) is the ability to imagine oneself experiencing events in the future (Atance and O’Neill, 2001). This cognitive ability is often referred to as future Mental Time Travel (MTT) (Berntsen & Jacobsen, 2008). The first part of this thesis is a systematic review and narrative synthesis of 16 papers that critically evaluates the relationship between EFT and measures of anxiety. Interest in this topic was generated from the theoretical and clinical accounts of anxiety that make reference to the expectation of future life events. Whilst there is not consensus across the papers, the review indicates some preliminary support in favour of a positive correlation between anxiety and frequency of EFT. It also discusses results that suggest how anxiety is associated with EFT that has abstract and negative content. Consideration for the clinical implications of the findings are also reviewed.The second part of this thesis is an empirical paper that investigates whether there is a direct relationship between the recall of episodic memory (past MTT) and the ability to engage in EFT (future MTT). It also examines whether deficits in MTT can be explained by an impaired search and retrieval strategy, as opposed to fragmented scene representation. Two female patients with focal hippocampal damage and documented autobiographical memory impairment, were asked to describe six events from their past and imagine six events they could potentially experience in their future. The GaltonCrovitz-Schiffman cue-word technique (Crovitz-Schiffman, 1974; Galton, 1879) was used to generate event descriptions. The patients were then prompted to elaborate on their descriptions using a pre-determined list of questions. The level of detail in their unprompted and prompted descriptions of past and future events was compared with five age-matched neurotypical controls. The empirical paper presents two preliminary findings. Firstly, that scaffolding, in the provision of verbal cues assisted both patients to provide more detail for their past events. Secondly, that there may be a dissociation between the two directions of MTT; one of the patients displayed a strong trend towards a selective deficit in her prompted future descriptions.
Aim and Background: This study was designed to determine the effect of unified transdiagnostic therapy on binge eating and difficulties in emotion regulation in patients with binge eating disorder. Methods and Materials: In this single-blind randomized controlled trial, the study population consisted of all women diagnosed with binge eating disorder in Kashan, Iran. Of those who went to the nutrition clinic in Kashan in the first half of 2015, 60 individuals of 19-52 years of age who were diagnosed with binge eating disorder were selected through purposive sampling and were randomly assigned to two groups in order to receive transdiagnostic therapy (n = 30) or remain on the waiting list (n = 30) for 12 weeks. The dependent variables were measured using the Binge Eating Scale (BES) (Gormally et al.) and Difficulties in Emotion Regulation Scale (DERS) (Gratz and Roemer). The collected data were analyzed using MANCOVA. Findings: After 12 weeks, compared with the control group, transdiagnostic therapy resulted in a significant reduction in binge eating (-8.46 ± 3.55 vs. -1.36 ± 1.90) (P < 0.001) and difficulties in emotion regulation results (-99.70 ± 33.91 vs. 15.43 ± 24.32) (P < 0.001). Conclusions: The behavioral component of unified transdiagnostic therapy focuses on the normalization of eating patterns, planning of meals, nutrition education, and culmination of the cycles of binge eating, and training of the individual to use smaller amounts of food regularly. Moreover, the cognitive component of this therapy focuses on coping with dysfunctional thoughts associated with binge eating. Generally, unified transdiagnostic therapy intervention had positive effects on binge eating disorder and difficulties in emotion regulation.
Background:
Intolerance of uncertainty (IU) has been proposed as a transdiagnostic risk and maintenance factor underlying various forms of psychopathology. Few studies, however, have examined IU in hoarding disorder (HD)-a condition characterized by excessive urges to acquire and difficulties discarding possessions-core symptoms that may be fueled by inflated IU. We examined cross-sectional relationships between IU and different symptom facets of HD, controlling for anxiety and depression severity, and explored whether pre-treatment levels of IU predicted response to exposure-based treatment for HD.
Method:
Fifty-seven individuals seeking treatment for HD completed baseline measures of hoarding symptoms, IU, anxiety and depression. Participants then completed 26 sessions of group exposure-based treatment for HD with or without compensatory cognitive training. Hoarding symptoms were assessed following the final treatment session to index treatment response.
Results:
IU was positively and significantly associated with greater urges to acquire and greater difficulties discarding possessions, beyond shared variance accounted for by anxiety and depression. IU was not significantly related to clutter symptom severity. Higher pre-treatment IU predicted increased odds of treatment non-response.
Conclusions:
Elevated IU is associated with specific hoarding symptom clusters and may be an important target for HD treatment.
Angststörungen zählen zu den häufigsten psychischen Störungen in der Allgemeinbevölkerung. Die Lebenszeitprävalenz liegt insgesamt bei 15–20 %. Diagnostisch werden folgende Untergruppen unterschieden: Panikstörung, die generalisierte Angststörung, die Agoraphobie, die soziale Phobie und die spezifischen Phobien. Ursache und Entstehung sind multifaktoriell bedingt. Angststörungen neigen häufig zu einem chronischen Krankheitsverlauf und gehen mit einer bedeutsamen psychosozialen Behinderung einher. Es existieren differenzierte störungsbezogene Ansätze von Pharmako- und Psychotherapie mit hohem Evidenz- und Empfehlungsgrad. Häufig ist auch eine Kombinationsbehandlung notwendig.
Increasing evidence suggests that intolerance of uncertainty (IU)
may be a transdiagnostic factor across the anxiety disorders, and
to a lesser extent, unipolar depression. Whereas anxiety inherently
involves uncertainty regarding threat, depression has traditionally
been associated with certainty (e.g. the hopelessness theory of
depression). Some theorists posit that the observed relationship
between depression and IU may be due to the relationship between
depression and anxiety and the relationship between anxiety and
IU. The present study sought to elucidate the unique relationships
among trait anxiety, depression, and IU in undergraduate (N = 554)
and clinical (generalized anxiety disorder; N = 43) samples. Findings
suggest that IU may play a larger role in anxiety than depression,
although some evidence indicates that inhibitory IU and depression
may have a modest but independent relationship.
The unified protocol for transdiagnostic treatment of emotional disorders (UP) includes therapeutic techniques and methods that have proven their efficacy and it is focused specifically on emotion regulation. Although the efficacy of UP has been proven in individual format, it is important to evaluate the delivery of the UP in other formats with the aim of improving cost-benefit. The aim of this pilot study was to evaluate the effectiveness and feasibility of UP in group format. Eleven patients with emotional disorders who attended a public mental health unit participated in the study. Primary outcomes were anxiety and depression symptoms, and secondary outcomes were positive and negative affect, impairment, general functioning, quality of life, and personality dimensions. At 12-month follow-up, 100% of the participants no longer met the diagnostic criteria for their main diagnosis, significant improvements were achieved in the primary outcomes and also in most secondary outcomes, including neuroticism scores. The administration of UP in a group format could be a suitable approach to treat emotional disorders in public mental health settings.
This study explores whether cognitive attributes differentiate depressed children from those with other psychiatric disorders. The subjects were 108 children from 7 to 17 years of age. Forty-seven children were diagnosed as currently depressed, 30 as having had an episode of major depression within the last year (depressed-resolved), and 31 with diagnoses other than depression (nondepressed). The subjects completed the Piers-Harris Children's Self-Concept Scale, the Children's Hopelessness Scale, the Nowicki-Strickland Children's Locus of Control Scale, the Children's Attributional Styles Questionnaire, and the Children's Depression Inventory. The depressed children endorsed significantly lower self-esteem, more hopelessness, a more externalized locus of control, and a more depressive attributional style than the depressed-resolved or the nondepressed children. Thus, a depressive cognitive style can be documented in clinically depressed young people. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The present study examined the relationships between learning experiences with respect to somatic symptoms and levels of anxiety sensitivity in youths. Fifty-two normal adolescents aged 12 to 14 years were interviewed about their learning experiences with anxiety-related and nonanxiety-related somatic symptoms and completed the Childhood Anxiety Sensitivity Index. Results showed that informational learning to some extent contributed to adolescents' anxiety sensitivity levels. That is, parents' transmission of the idea that somatic symptoms might be dangerous was significantly associated with levels of anxiety sensitivity. Other learning experiences such as parental reinforcement or observational learning were not found to be related to anxiety sensitivity. It can be concluded that learning experiences seem to play a small but significant role in the development of high levels of anxiety sensitivity.
The role of the amygdala in mediating the anxiolytic effects of diazepam was examined in two models of rat anxiety. As in our previous experiments, amygdaloid lesions by themselves did not increase rats' exploration of the open arms of the elevated plus-maze or decrease rats' burying of an electrified probe in the shock-probe burying test. However, amygdaloid lesions did increase rats' shock-probe contacts. Diazepam (2 mg/kg) increased open-arm activity and decreased burying behavior to an equal extent in sham-lesioned and amygdala-lesioned rats and had no significant effect on the facilitation of probe contacts induced by amygdaloid lesions. These results suggest that many of the anxiolytic effects of benzodiazepines are not mediated by the amygdala.
To assess the effects of distraction and level of erotic stimulation on physiological and subjective sexual arousal, sexually dysfunctional (n = 23) and functional (n = 26) men were studied. It was hypothesized from previous investigations that men with erectile dysfunction would show a different genital response pattern to distraction during sexual stimulation when compared with sexually functional men. Distraction load was manipulated through different verbal instructions about how to deal with pairs of random digits. Erotic stimulation level was manipulated through the selection of erotic video content. In both groups, increasing distraction was found to increasingly inhibit genital responding, but not to affect subjective arousal. Both physiological and subjective arousal were higher when erotic stimulation level was high. An interaction effect of distraction and erotic stimulation level was observed: the linear dose-response association that was found during high erotic stimulation was not found under low stimulation conditions, which may reflect a floor effect. The implications of the findings for the cognitive theory of sexual arousal disorder are discussed.
This chapter reviews the principles and premises of operant conditioning, before exploring the utility of these principles in understanding the onset and maintenance of phobic and anxiety disorders. It examinesthese principles and their utility in the treatment of these disorders, and explores developmental issues associated with operant factors in the onset,maintenance, and treatment of these disorders.
The effects of controllable versus uncontrollable appetitive stimulation on socioemotional development were studied in 20 infant rhesus monkeys reared in 5 peer groups consisting of 4 monkeys each. In 2 groups (Masters), subjects had access to operant manipulanda that permitted them to control the delivery of food, water, and treats. In 2 other groups (Yoked), subjects received access to these reinforcers noncontingently. In a fifth group (Standard Rearing Control), subjects were reared in a standard laboratory cage without access to the manipulanda and the variety of reinforcers available in the Master and Yoked groups. Subjects were introduced to these rearing environments during the second month of life; during the second half of the first year, tests of socioemotional behavior commenced. Results indicated that Master subjects displayed less fear, as measured by reactions to a mechanical toy robot, and exhibited more exploratory behavior, as measured by responses to a standard primate playroom, than did Yoked subjects. Master and Yoked subjects did not differ on measures of response to social separation from peers, unless opportunities to make active coping attempts were provided, in which case Master subjects appeared to adapt or cope better. On most measures, Yoked subjects did not differ from Standard Rearing Controls. Thus the above results could be attributed to the effects of experience with increased control over appetitive environmental events rather than to the effects of prolonged exposure to noncontingent or uncontrollable appetitive stimulation.
The goal of the present study was to examine the factor structure of the Anxiety Sensitivity Index (ASI; S. Reiss, R. A. Peterson, D M. Gursky, & R. J. McNally, 1986) and the replicability, reliability, and validity of its dimensions in a nonclinical sample. One-thousand-and-seventy-one undergraduate volunteers completed the ASI and a modified version of the Panic Attack Questionnaire (PAQ; G. R. Norton, J. Dorward, & B. J. Cox, 1986). A principal components analysis, using oblique rotation and parallel analysis, yielded three ASI dimensions that were highly consistent with those reported in previously published studies. Individuals classified as nonclinical panickers scored higher than nonpanickers on the Physical Concerns and Cognitive Concerns subscales of the ASI. Although spontaneous panic attacks were not significantly related to scores on any ASI scale, the occurrence of panic attacks in the past month was related to higher scores on the Cognitive Concerns subscale. The results are discussed in terms of cognitive theories of panic, and limitations of the present study and directions for future research are addressed.
The relationship between a number of social and cognitive variables and depressive symptomatology was evaluated in a sample of public middle-school and high-school students. The variables measured included stressful life events, locus of control, causal attributions, and means-ends problem-solving abilities. Higher levels of depression were found to be associated with a more external locus of control and a tendency to attribute outcomes to causes which are internal, stable, and global. Parental divorce and socioeconomic status were also found to be associated with higher levels of depression. No relationship was found to exist between either amount of life stress or problem-solving ability and depression. The implications of these results for delineating the underlying dimensions of depression in adolescents are discussed.
The content, form, structure and functional characteristics of intrusive thinking were studied in a group of sixty adult subjects. The content and form of these intrusive activities resembled obsessions but were less intense and less disturbing. The intrusive thoughts, images and impulses shared important features but some differences were noted. Analysis of the intrusions yielded two major factors, distressing qualities and controllability. The dismissability of intrusions was related to their intensity and distressing qualities. A surprisingly large proportion of intrusions were triggered by external precipitants.
The present study examined the concurrent validity of the Nowicki-Strickland Locus of Control Scale with the State-Trait Anxiety Inventory for Children. In all, 267 students (131 males and 136 females), in grades five through eight participated. Pearson product-moment correlations indicated significant relationships between these measures for both males and females. Implications are discussed.
The effects of low efficacy expectancies on sexual arousal in sexually functional men were examined. Twenty-six participants were randomly assigned to either a false negative feedback group or a no-feedback group. Measures of physiological arousal, subjective arousal, efficacy expectancies, and affect were obtained. After viewing two erotic films, participants in the false feedback group were told that their response was less than that of the average participant. Participants in the control group did not receive any feedback. Results indicated that false feedback lowered the level of efficacy expectancies and led to a significant decline in physiological response to a third erotic film. Moreover, post-feedback efficacy expectancies were strongly associated with physiological response to the third film. Counter to predictions and despite its effects on physiological arousal, false feedback did not lead to a significant decline in subjective arousal or an increase in negative affect. Results are discussed in terms of the importance of cognitive factors in the etiology and treatment of sexual dysfunction.
Two groups of socially housed rhesus monkeys were raised under conditions differing in the degree of control or mastery over
appetitive stimuli (food, water, and treats) in the 1st year of life. At age 18–24 months, a benzodiazepine receptor inverse
agonist, β-carboline-3-carboxylic acid ethyl ester (β-CCE), was administered to both social groups to investigate the effects
of differential rearing on the response to a putative anxiogenic drug. In both groups β-CCE was followed by behavioral activation
with a profile suggesting increases in aggression rather than fear or anxiety. A group by drug analysis revealed that the
increase in aggression was observed predominantly in the subjects reared with mastery during the 1st year. Plasma cortisol
increased in both groups, but its increase was greater in the yoked subjects. These results suggest that early experience
with controllability may have long term consequences which can be revealed by challenge with β-CCE.
Many behavior therapists have questioned the adequacy of direct respondent conditioning for explaining phobic fear acquisition because fears may develop in the absence of direct experience with environmental trauma. Much of the debate has been fueled by confusion about what constitutes a traumatic event, and what is it that is being conditioned in phobic fear. The purpose of this paper is to (a) review recent arguments for and against direct traumatic conditioning based on clinical observation and laboratory conditioning studies, and (b) present an alternate view of direct conditioning that does not require a readily identifiable conditioned stimulus (CS) or unconditioned stimulus (UCS). What is required is a negatively evaluated abrupt and aversive systemic response (“alarm”) that constitutes the primary conditioning event in human fear acquisition. Using examples of specific phobias and illness fears, we illustrate how alarms can account for fear acquisition without a readily identifiable aversive environmental event.
The purpose of this study was to (a) compare people who experienced recent panic attacks (panickers) with nonpanickers and (b) determine, the factors associated with panic attacks in nonclinical subjects. Two hundred and fifty-six students completed the Panic Attack Questionnaire (PAQ), the State-Trait Anxiety Inventory (STAI), the Beck Depression, Inventory (BDI), the Profile of Mood States (POMS), and two measures of fear/avoidance. Over 22% of the subjects reported one or more panic attacks in the 3 weeks, prior to testing. Comparisons of panickers and nonpanickers showed that panickers (a) scored higher on measures of anxiety, depression, etc., and (b) reported more first-order relatives who have panic attacks. The panic attacks were characterized by (a) having a sudden onset, (b) an average of eight DSM-III symptoms, and (c) occurring in a wide variety of situations (especially social situations). Subjects who experienced unpredictable panic attacks differed, on several measures from subjects with only predictable attacks. Finally, panickers reported experiencing several symptoms not included in DSM-III. Similarities, between panickers and patients with Panic Disorder and Agoraphobia and the assessment of panic-related, disorders are discussed.
Preliminary data from a blind direct interview family study indicate a significantly higher risk for simple phobia among first-degree relatives (n = 49) of simple phobic probands (who had no other anxiety disorder) as compared with first-degree relatives (n = 119) of never mentally ill controls (31% vs 11%, relative risk = 3.3). Female relatives were more likely to be affected than male relatives (48% vs 13%), though this difference did not reach conventional significance in an age-corrected analysis. Significant between-group differences were not found in risks for (1) other anxiety, affective, and substance abuse disorders, and (2) simple irrational fears that did not meet disorder criteria. The results suggest that simple phobia is a highly familial disorder that does not transmit increased risk for other phobic or anxiety disorders. The specificity of increased risk among the relatives of simple phobics is consistent with the distinction between simple phobia, social phobia, and agoraphobia. However, complete delineation of the transmissional relationship between these illnesses requires assessment of the extent to which risk for simple phobia can be transmitted by individuals with other phobic or anxiety disorders. Replication of these preliminary findings in larger clinically and epidemiologically selected samples is needed.
One hundred and fifty-one non-clinical Ss and 18 patients suffering panic disorder with agoraphobia completed a questionnaire to assess their experience of physiological sensations and their emotional reactions to these sensations. The non-clinical group was divided into those who reported having ever experienced a DSM-III-R uncued panic attack (n = 21) and those who did not (n = 130). The results indicated that physiological sensations characteristic of panic attacks are commonly experienced by non-clinical Ss. The major difference between panic disorder patients and non-clinical Ss who had never experienced a panic attack is that the former group are far more likely to respond with anxiety to the sensations. Non-clinical panickers fall between the other two groups in terms of their anxious response to physical sensations. The panic disorder Ss report a greater intensity, duration and frequency of the physiological sensations than either of the non-clinical groups. The results provide some support for biopsychosocial models of panic attacks.
Thirty driving phobics who called the Psychiatry Outpatient Phobia Clinic (25 females and five males) were given a 20-min semi-standardized telephone interview during which they were asked about the circumstances of the onset of their driving fears. Twelve (40%) reported that their fears were precipitated by a panic attack on the freeway; six (20%) by a collision; and three (10%) by other frightening experiences in automobiles. Four (13.3%) related the onset to family stress or upheaval. Other modes of onset also occurred. The implications of these findings are discussed in terms of existing theories of fear acquisition and treatment approaches.
In a study of 229 neurotic same-sex adult twins admitted to all psychiatric in- and out-patient clinics and mental hospitals in Norway, a statistically significant, moderately higher concordance was found for MZ than for DZ twins. When the sample was subdivided, this higher concordance for MZ pairs was true only for male twins and for twins admitted to mental hospitals. The results are compared to those from earlier studies; different findings on the importance of genetic factors in the development of neuroses may be due to differences in sample selection.
Of 102 systematically interviewed children, age 7 to 17 years, 28 met DSM-III criteria for depressive disorders and 14 for anxiety disorders. Because the adult psychiatric literature suggests overlapping symptomatology between these disorders, depressive and anxiety symptoms were compared in these groups of children. Depressed children, like depressed adults, reported many anxiety symptoms. However, anxious children, unlike their adult counterparts, never reported panic attacks and complained much less often of depressive symptoms. In contrast to adults with anxiety disorders, no child met criteria for a secondary depression. Longitudinal studies and validation measures for diagnoses of anxiety and depressive disorders are necessary for more definitive conclusions. This study suggests that there are more similarities between childhood and adult depressive disorders than anxiety disorders.
In an effort to learn how perceived internal control changes with age, 33 developmental studies using 12 different locus of control (LOC) scales are surveyed. A few studies show developmental declines in perceived control, about half show consistent developmental increases, and about half show mixed results or no significant developmental differences. A critical examination of the LOC scales reveals that some developmental findings may be artifacts of scale characteristics, and that others may reflect developmental effects on constructs other than perceived control. Most importantly, the scales and the LOC literature fail to distinguish clearly betwen two dimensions of perceived control that may show quite different patterns of developmental change. These dimensions are perceived contingency of outcomes and perceived competence of self; combined, they form a simple but potentially powerful conceptual framework for theory and research on the development of perceived control. The explanatory power of this framework is briefly illustrated, relevant evidence is surveyed, and embryonic proposals are advanced for the study of perceived contingency and competence independently and in interaction.Copyright © 1982 S. Karger AG, Basel
In a recent stimulating article, Dr Klein1(p306) boldly proposed that "many spontaneous panics occur when the brain's suffocation monitor erroneously signals a lack of useful air, thereby maladaptively triggering an evolved suffocation alarm system." Klein postulated that this is a physiological mechanism and that spontaneous panic attacks occur when the suffocation alarm threshold is pathologically lowered, or when psychosocial cues to suffocation are particularly salient. The theory spans a wide range of phenomena, although its primary focus is on spontaneous panic attacks.
We investigated the theory's main assumption that suffocation alarm hypersensitivity is a risk factor for panic disorder. Alarm hypersensitivity was operationalized by a recently developed measure of suffocation fear,2 which we administered to a sample of 179 university students. The sample's mean age was 20 years and two thirds were women. We reasoned that people with hypersensitive alarms are more likely to have their
In summary, VFD subjects appear to have sustained long-term behavioral and biologic sequelae following disruption of normative maternal-infant attachment patterns. The sequelae are primarily manifest as stable anxiety or affective traits and, from a biologic perspective, are most analogous to recent data that have emerged from studies of patients with PTSD. Multiple abnormalities are observed of systems directly involved in affect regulation. Further studies are required to clarify the pathologic ontogeny of the VFD condition and its potential relevance to human psychopathology.
We investigated predictors of response to carbon dioxide challenge (i.e. breathing deeply and rapidly into a paper bag for 5 min) in college students. Zero-order correlations indicated that scores on both the Anxiety Sensitivity Index (ASI: Reiss, Peterson, Gursky & McNally, 1986) and the Suffocation Fear Scale (SFS: Rachman & Taylor, 1994), predicted anxious response to challenge, whereas a behavioral measure of carbon dioxide sensitivity (i.e. maximum breath-holding duration) and scores on the State-Trait Anxiety Inventory--Trait form (STAI-T: Spielberger, Gorsuch, Lushene, Vagg & Jacobs, 1983) did not. Multiple regression revealed that all four variables remained in the model, entering in the following order: ASI, breath-holding duration, SFS, and STAI-T. These data suggest that psychological variables reflecting fears of bodily sensations are better predictors of response to challenge than either behavioral sensitivity to carbon dioxide or general trait anxiety.
This paper summarises the methods and sources of data used to estimate costs of affective disorders and presents the results.
A timing model employing regression analysis was developed to estimate morbidity costs. This model measures the lifetime effect on current income of individuals with affective disorders, taking into account the timing of onset and the duration of these disorders.
Affective disorders imposed an estimated US 30.4 billion in 1990 in the US. Affective disorders represent 21% of the costs of all mental illnesses. Direct treatment costs comprised 58.4% of the total in 1985; morbidity costs, 8.1%; mortality costs, the present value of future earnings lost due to premature mortality, 28.9%, based on a 6% discount rate; and other related costs, including the cost of crime, lost productivity due to incarceration, and caregiver services, 4.6%. Private sources account for 49% of the total direct expenditures for treatment of persons with affective disorders; state and local funds, 26%; and federal funds, 25%.
In light of the high burden of affective disorders on societal resources, more attention should be directed at comprehensive, research-based strategies to reduce the prevalence of these disorders in the United States.
We evaluated for phobias the prediction of the stress-diathesis model that the magnitude of stress at onset is inversely proportional to the level of underlying diathesis.
In more than 7500 twins from a population-based registry, we assessed the personality trait of neuroticism--as an index of phobia-proneness--and the lifetime histories of 5 phobia subtypes (agoraphobia, social, animal, situational, and blood or injury) and their associated irrational fears. Interviewers classified the mode of acquisition of the fear in phobic twins into 5 possible categories: trauma to self (further divided by severity), observed trauma to others, observed fear in others, taught by others to be afraid, and no memory of how or why fear developed. Analyses were conducted by logistic regression and analysis of covariance.
The mode of acquisition had moderate test-retest reliability and differed meaningfully across phobia subtypes. None of the 3 tests of the stress-diathesis model was confirmatory: (1) the risk of phobias was not elevated in co-twins of twins who had no memory of their mode of acquisition, (2) the risk of phobias was not decreased in co-twins of twins who had severe trauma to self, and (3) no significant relationship, in phobic twins, was found between levels of neuroticism and mode of acquisition.
These results are inconsistent with the traditional etiologic theories for phobias, which assume conditioning or social transmission. However, they are compatible with nonassociative models, which postulate that the vulnerability to phobias is largely innate and does not arise directly from environmental experiences. The stress-diathesis model may not be an appropriate paradigm for phobic disorders.
Examination of the prospective relation between anxiety sensitivity (AS) and behavioral avoidance is largely absent from the literature. In a longitudinal study of a community sample of 2246 adolescents, participants completed the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally (1986). Behaviour Research & Therapy, 24, 1-8), State-Trait Anxiety Inventory (STAI; Spielberger (1983). STAI: Manual for the Stait-Trait Anxiety Inventory. Palo Alto: Consulting Psychologists Press), and the Fear Questionnaire (Marks & Matthews (1979). Behaviour Research & Therapy, 17, 263-267) on an annual basis. To stringently test AS's ability to prospectively predict behavioral avoidance, linear regression was used to test whether AS factors predicted variance in follow-up behavioral avoidance scores after controlling for gender, trait anxiety, panic attacks, and baseline avoidance. Results indicted that the mental and physical subscales of the ASI predicted change in behavioral avoidance. The findings of the study are consistent with the view that AS may serve as a precursor to avoidant behavior and that, regardless of whether or not acute panic has been experienced, those who fear autonomic arousal may be more likely to avoid situations in which those sensations may be present.
The effects of appetitive controllability on behavioral and cortisol reactivity to novelty in 12 infant rhesus monkeys were studied. Surrogate-peer-reared infants had homecage access to food treats contingently via lever pressing ("master") or noncontingently ("yoked") for 12 weeks from postnatal month 2. Masters lever-pressed more, but did not differ in baseline cortisol. At month 5, infants were exposed to a novel environment in social groups and individually. Masters were significantly more active and exhibited significantly lower cortisol reactivity to the novel environment, but only in the individual context. Also, individual differences in operant behavior were positively correlated with behavioral activity and negatively correlated with cortisol reactivity to the novel environment. The results reveal context-specific benefits of contingent stimulation in infancy.
The present investigation evaluated affect intensity in regard to anxious and fearful responding to a voluntary hyperventilation paradigm. Participants were 90 young adults without a history of Axis I psychopathology or nonclinical panic attacks. The incremental validity of affect intensity was examined relative to gender, negative affectivity, anxiety sensitivity, and anticipatory anxiety. As hypothesized, affect intensity significantly and incrementally predicted the perceived intensity of post-challenge panic-relevant physical and cognitive symptoms but not physiological arousal. Findings are discussed in relation to better understanding the role of affect intensity as a potential risk factor for panic-related problems.