Georg H. Eifert

Negative-reinforcement drinking motives mediate the relation between anxiety sensitivity and increased drinking behavior

Abstract We examined whether certain “risky” drinking motives mediate the previously established relation between elevated anxiety sensitivity (AS) and increased drinking behavior in college student drinkers (n=109 women, 73 men). Specifically, we administered the Anxiety Sensitivity Index (ASI), Revised Drinking Motives Questionnaire, and a quantity-frequency measure of typical drinking levels. Participants were parceled according to high (n=30), moderate (n=29), and low (n=34) AS levels. As expected, high AS participants reported a higher typical weekly drinking frequency than the low and moderate AS students regardless of gender. Similarly, high AS participants (particularly high AS men) reported a higher yearly excessive drinking frequency than low AS students. Only the negative reinforcement motives of Coping and Conformity were found to independently mediate the relations between AS and increased drinking behavior in the total sample. High AS womens greater drinking behavior was largely explained by their elevated Coping Motives, while heightened Conformity Motives explained the increased drinking behavior of high AS men. Finally, associations between AS and increased drinking behavior in university students were largely attributable to the “social concerns” component of the ASI. We discuss the observed relations with respect to the psychological functions of drinking behavior that may portend the development of alcohol problems in young adult high AS men and women.

The relations of anxiety sensitivity, experiential avoidance, and alexithymic coping to young adults' motivations for drinking.

The authors examined whether motivations for drinking alcohol are associated with the anxietyrelated dispositional tendencies of anxiety sensitivity, experiential avoidance, and alexithymic coping. The authors administered the Anxiety Sensitivity Index, Experiential Avoidance Scale, 20-item Toronto Alexithymia Scale, Revised Drinking Motives Questionnaire, and a demographics questionnaire to 182 university drinkers. In multiple regressions, the dispositional factors significantly predicted the risky drinking motives of coping, enhancement, and conformity. Coping and enhancement motives were significantly predicted by experiential avoidance. Conformity motives were significantly and independently predicted by anxiety sensitivity and alexithymia. The process of experiential avoidance mediated the bivariate correlation between anxiety sensitivity and coping-motivated drinking to a greater extent than did the process of alexithymic coping. The authors discuss the observed relations in regard to the psychological functions of drinking behavior that may portend the development of heavy drinking and alcohol problems in dispositionally vulnerable individuals. They also review implications for refinements of behavior therapy for problem drinkers.

A review of psychological factors/processes affecting anxious responding during voluntary hyperventilation and inhalations of carbon dioxide-enriched air

Despite advances in our understanding of the nature of anxiety-related responding during periods of elevated bodily arousal, it is not necessarily evident by what psychological mechanisms anxiety is produced and maintained. To address this issue, researchers have increasingly employed biological challenge procedures to examine how psychological factors affect anxious responding during elevated bodily arousal. Of the challenging procedures, hyperventilation and inhalations of carbon dioxide-enriched air have been among the most frequently employed, and a relatively large body of literature using these procedures has now accumulated. Unfortunately, existing reviews do not comprehensively examine findings from hyperventilation and inhalations of carbon dioxide studies, and only rarely the methodological issues specific to these studies. To address these issues, we review the voluntary hyperventilation and carbon dioxide-enriched air literature in order to identify the primary methodological issues/limitations of this research and address the extent to which psychological variables influence anxious responding to such challenges. Overall, we conclude challenge research is a promising paradigm to examine the influence of psychological variables in anxious responding, and that such work will likely be enhanced with greater attention to psychological process issues.

The Cardiac Anxiety Questionnaire: development and preliminary validity

Heart-focused anxiety (HFA) is the fear of cardiac-related stimuli and sensations because of their perceived negative consequences. Although HFA is common to a wide variety of persons who experience chest pain and distress, it often is unrecognized and misdiagnosed, particularly in cardiology and emergency room patients without and with heart disease. To address these concerns, this article reports on the development and preliminary psychometric evaluation of the Cardiac Anxiety Questionnaire (CAQ) designed to measure HFA. In Study 1, 188 cardiology patients completed the CAQ. Item and factor analyses indicated a three-factor solution pertaining to heart-related fear, avoidance, and attention. Reliability analysis of the 18-item CAQ revealed good internal consistency of the total and subscale scores. In Study 2, 42 patients completed the CAQ and several other anxiety-related questionnaires to assess its convergent and divergent properties. Although preliminary validity results are promising, further psychometric study is necessary to cross-validate the CAQ, examine its test-retest reliability, and confirm the stability of the factor structure. Taken together, the CAQ appears to assess HFA, and may therefore be a useful instrument for identifying patients with elevated HFA without and with heart disease.

Acceptance and commitment therapy in the treatment of an adolescent female with anorexia nervosa: A case example

Acceptance and Commitment Therapy (ACT) is a cognitive-behavioral treatment that targets ineffective control strategies and experiential avoidance—the unwillingness to accept negative thoughts, feelings, and emotions. Although ACT has been suggested as an effective treatment for panic, substance use, pain, and mood disorders, there are no published reports on the use of ACT for treating adolescent disorders such as anorexia nervosa. This case summarizes the successful adoption of ACT techniques in the treatment of a 15-year-old female with anorexia nervosa. It also shows how ACT techniques can be successfully combined with, and set the stage for, more standard cognitive-behavioral interventions.

Affective style among smokers: Understanding anxiety sensitivity, emotional reactivity, and distress tolerance using biological challenge

The present investigation evaluated affective style in terms of anxiety sensitivity, emotional reactivity, and distress tolerance in heavy smokers. Specifically, heavy smokers (> or = 20 cigarettes per day) were partitioned into those who were able to quit for at least 7 days (n = 10) and those who were able to quit for less than 7 days (n = 12). All participants completed measures of anxiety sensitivity and maximum breath-holding duration and then were exposed to a 20% carbon dioxide-enriched air challenge. Results indicated that heavy smokers who had not been able to remain abstinent from smoking for at least 1 week during a quit attempt demonstrated significantly greater cognitive-affective reactivity to the challenge relative to their counterparts but did not differ at a physiological level of analysis. Contrary to our hypotheses, neither anxiety sensitivity scores nor maximum breath-holding duration significantly differed between the groups. These findings are discussed in relation to better understanding affective style among heavy smokers.

Cardiophobia: A paradigmatic behavioural model of heart-focused anxiety and non-anginal chest pain

Cardiophobia is defined as an anxiety disorder of persons characterized by repeated complaints of chest pain, heart palpitations, and other somatic sensations accompanied by fears of having a heart attack and of dying. Persons with cardiophobia focus attention on their heart when experiencing stress and arousal, perceive its function in a phobic manner, and continue to believe that they suffer from an organic heart problem despite repeated negative medical tests. In order to reduce anxiety, they seek continuous reassurance, make excessive use of medical facilities, and avoid activities believed to elicit symptoms. The relationship of cardiophobia to illness phobia, health anxiety, and panic disorder is discussed. An integrative psychobiological model of cardiophobia is presented which includes previous learning conditions relating to experiences of separation and cardiac disease; deficient and inappropriate behavioural repertoires which constitute a psychological vulnerability for cardiophobic problems; negative life events, stressors, and conflicts in the persons present situation that trigger and contribute to the symptoms; current affective, cognitive, and behavioural symptoms and their stimulus properties; and genetic and acquired biological vulnerability factors. Finally, recommendations for the treatment of cardiophobia are derived from the model and areas of future research are outlined.

The effects of running and meditation on beta-endorphin, corticotropin-releasing hormone and cortisol in plasma, and on mood

The relations between three hormones of the hypothalamic-pituitary-adrenocortical (HPA) axis, beta-endorphin (beta-EP), corticotropin-releasing hormone (CRH) and cortisol, and mood change were examined in 11 elite runners and 12 highly trained mediators matched in age, sex, and personality. Despite metabolic differences between running and meditation, we predicted that mood change after these activities would be similar when associated with similar hormonal change. Compared to pre-test and control values, mood was elevated after both activities but not significantly different between the two groups at post-test. There were significant elevations of beta-EP and CRH after running and of CRH after meditation, but no significant differences in CRH increases between groups. CRH was correlated with positive mood changes after running and mediation. Cortisol levels were generally high but erratic in both groups. We conclude that positive affect is associated with plasma CRH immunoreactivity which itself is significantly associated with circulating beta-EP supporting a role for CRH in the release of beta-EP. Increased CRH immunoreactivity following meditation indicates, however, that physical exercise is not an essential requirement for CRH release.

Manualized behavior therapy: Merits and challenges

Treatment manuals have been hailed as an important breakthrough in the development, evaluation, and dissemination of empirically validated therapies. Yet manualized behavior therapy has also been criticized because (a) practice involves the application of validated principles of behavior rather than the application of fixed strategies, and (b) successful behavioral interventions must supposedly be based on an idiographic functional problem analysis and tailored to each individual patient. This article evaluates the relative merits, potential limitations, and misconceptions about the use of manuals. We conclude that individualizing treatment and manual use are not mutually exclusive and propose that manuals be used in a flexible theory-driven fashion guided by empirically tested clinical decision rules.

The relation between anxiety and skill in performance-based anxiety disorders: A behavioral formulation of social phobia

Anxiety-related responding and skill deficits have historically been associated with performance-based anxiety disorders such as social phobia. Prominent cognitive-behavioral models of social phobia have typically deemphasized skill deficits and focused more on the effects of negative cognition on social performance. Considering that empirical accounts of the relation between social skill and social performance are generally modest, the impact of skill deficits on the development and maintenance of performance inadequacies may be relatively neglected in theoretical paradigms in this area. A second problem that has plagued social skill research is the misuse of the term skill deficit as a synonym for performance deficit. In response to these issues, we utilize the multilevel framework of psychological behaviorism to offer a more parsimonious account of the relation between anxiety and skill in social phobia. We argue that this integrated model assimilates contemporary accounts of social phobia and uniquely expands upon them by delineating the unique and cumulative effects of skill and anxiety on social performance. We further suggest that this model resolves existing theoretical incompatibilities, facilitates improved patient-treatment matching, and shows promise as a guiding framework for empirical research.