Kamila S. White

Evaluation of Responding in Peaceful and Positive Ways (RIPP): A School-Based Prevention Program for Reducing Violence Among Urban Adolescents

Evaluated Responding in Peaceful and Positive Ways (RIPP)-a 6th-grade universal violence prevention program. Classes of 6th graders at 3 urban middle schools serving predominantly African American youth were randomized to intervention (N = 321) and control groups (N = 305). Intervention effects were found on a knowledge test but not on other mediating variables. RIPP participants had fewer disciplinary violations for violent offenses and in-school suspensions at posttest compared with the control group. The reduction in suspensions was maintained at 12-month follow-up for boys but not for girls. RIPP participants also reported more frequent use of peer mediation and reductions in fight-related injuries at posttest. Intervention effects on several measures approached significance at 6-month and 12-month follow-up. The programs impact on violent behavior was more evident among those with high pretest levels of problem behavior.

Impact of Exposure to Community Violence on Anxiety: A Longitudinal Study of Family Social Support as a Protective Factor for Urban Children

In a longitudinal study, we examined the relationship between exposure to community violence and anxiety, and the extent to which family social support moderated this relationship within a predominantly African American sample of 385 children in an urban public school system. Children reported notably lower anxiety levels compared to normative data for African American children. A high percentage reported witnessing a variety of violent acts. Cross-sectional results indicated that among girls exposure to violence was significantly correlated with total, physiological, and concentration anxiety. Among boys violence exposure was not associated with anxiety. Hierarchical regression analyses indicated that after controlling for gender, exposure to violence at Time 1 did not significantly predict changes in anxiety. A significant interaction was found for gender and exposure to violence on concentration anxiety; girls who reported higher initial violence exposure reported greater increases in subsequent concentration anxiety than boys. Whereas findings from our study did not support a moderating relationship of family social support on childrens exposure to violence and anxiety, a strong negative relationship was found between anxiety and family support. Among children with initially low worry anxiety, those with low family social support showed greater increases in subsequent worry anxiety.

Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome

Research evaluating the relationship of comorbidity to treatment outcome for panic disorder has produced mixed results. The current study examined the relationship of comorbid depression and anxiety to treatment outcome in a large-scale, multi-site clinical trial for cognitive-behavior therapy (CBT) for panic disorder. Comorbidity was associated with more severe panic disorder symptoms, although comorbid diagnoses were not associated with treatment response. Comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) were not associated with differential improvement on a measure of panic disorder severity, although only rates of comorbid GAD were significantly lower at posttreatment. Treatment responders showed greater reductions on measures of anxiety and depressive symptoms. These data suggest that comorbid anxiety and depression are not an impediment to treatment response, and successful treatment of panic disorder is associated with reductions of comorbid anxiety and depressive symptoms. Implications for treatment specificity and conceptual understandings of comorbidity are discussed.

The structure of perceived emotional control: Psychometric properties of a revised anxiety control questionnaire

The psychometric properties of the Anxiety Control Questionnaire (ACQ) were evaluated in 1,550 outpatients with DSM-1V anxiety and mood disorders and 360 nonclinical participants. Counter to prior findings, exploratory factor analyses produced a 3-factor solution (Emotion Control, Threat Control, Stress Control) based on 15 of the ACQs original 30 items. Factor analyses in two independent clinical samples (e.g., confirmatory factor analysis, CFA) replicated the 3-factor solution. Multiple-groups CFAs indicated that the measurement properties of the ACQ were invariant in male and female patients, and that the ACQ was largely form and parameter equivalent in a clinical versus nonclinical sample. Hierarchical analysis supported the existence of a higher-order dimension of perceived control. Structural regression analyses indicated that each of the ACQ factors accounted for significant unique variance in one or both latent factors representing the dimensions of autonomic anxiety and depression. The results are discussed in regard to their conceptual and psychometric implications to the construct of perceived emotional control.

Morbidity of DSM-IV Axis I disorders in patients with noncardiac chest pain: Psychiatric morbidity linked with increased pain and health care utilization.

The present study examined current and lifetime psychiatric morbidity, chest pain, and health care utilization in 229 patients with noncardiac chest pain (NCCP), angina-like pain in the absence of cardiac etiology. Diagnostic interview findings based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) revealed a psychiatrically heterogeneous sample of whom 44% had a current Axis I psychiatric disorder. A total of 41% were diagnosed with a current anxiety disorder, and 13% were diagnosed with a mood disorder. Overall, 75% of patients had an Axis I clinical or subclinical disorder. Lifetime diagnoses of anxiety (55%) and mood disorders (44%) were also prevalent, including major depressive disorder (41%), social phobia (25%), and panic disorder (22%). Patients with an Axis I disorder reported more frequent and more painful chest pain compared with those without an Axis I disorder. Presence of an Axis I disorder was associated with increased life interference and health care utilization. Findings reveal that varied DSM-IV Axis I psychiatric disorders are prevalent among patients with NCCP, and this psychiatric morbidity is associated with a less favorable NCCP presentation. Implications for early identification of psychiatric disorders are discussed.

Anxiety and Hypervigilance to Cardiopulmonary Sensations in Non-Cardiac Chest Pain Patients With and Without Psychiatric Disorders

We investigated body vigilance, cardiac anxiety, and the mediating role of interoceptive fear on pain in patients with non-cardiac chest pain (NCCP; a syndrome of chest pain in the absence of identifiable organic etiology). Patients were more attentive to cardiac-congruent sensations than cardiac-incongruent sensations (e.g., gastrointestinal, cognitive dyscontrol; ps < .001). Patients with a DSM-IV Axis I anxiety or mood disorder were more body vigilant compared to patients who did not have a disorder (ps < .05). Patients with anxiety disorders were particularly vigilant to and fearful of cardiac sensations relative to patients without anxiety disorders. Latent variable path models examined the extent that interoceptive fear mediated the association between body vigilance and cardiac anxiety on chest pain. Within each model, diagnostic status, body vigilance, and cardiac anxiety were exogenous and predicted interoceptive fear that in turn predicted pain. Separate models examined body vigilance and cardiac anxiety, and both models fit the data well. Findings showed partial mediation for the body vigilance factor, and full mediation for the cardiac anxiety factor. Interoceptive fear played a mediating role in both models. The syndrome of NCCP may persist partly due to conscious hypervigilance to and fear of cardiac-congruent body sensations, particularly among anxious patients.

Mechanisms of change in cognitive behavioral therapy for panic disorder: The unique effects of self-efficacy and anxiety sensitivity

The present study examined temporal dependencies of change of panic symptoms and two promising mechanisms of change (self-efficacy and anxiety sensitivity) during an 11-session course of cognitive-behavior therapy (CBT) for Panic Disorder (PD). 361 individuals with a principal diagnosis of PD completed measures of self-efficacy, anxiety sensitivity, and PD symptoms at each session during treatment. Effect size analyses indicated that the greatest changes in anxiety sensitivity occurred early in treatment, whereas the greatest changes in self-efficacy occurred later in treatment. Results of parallel process latent growth curve models indicated that changes in self-efficacy and anxiety sensitivity across treatment uniquely predicted changes in PD symptoms. Bivariate and multivariate latent difference score models indicated, as expected, that changes in anxiety sensitivity and self-efficacy temporally preceded changes in panic symptoms, and that intraindividual changes in anxiety sensitivity and self-efficacy independently predicted subsequent intraindividual changes in panic symptoms. These results provide strong evidence that changes in self-efficacy and anxiety sensitivity during CBT influence subsequent changes in panic symptoms, and that self-efficacy and anxiety sensitivity may therefore be two distinct mechanisms of change of CBT for PD that have their greatest impact at different stages of treatment.

Antidepressant Medication Augmented With Cognitive-Behavioral Therapy for Generalized Anxiety Disorder in Older Adults

OBJECTIVE Generalized anxiety disorder is common among older adults and leads to diminished health and cognitive functioning. Although antidepressant medications are efficacious, many elderly individuals require augmentation treatment. Furthermore, little is known about maintenance strategies for older people. The authors examined whether sequenced treatment combining pharmacotherapy and cognitive-behavioral therapy (CBT) boosts response and prevents relapse in older adults with generalized anxiety disorder. METHOD Participants were individuals at least 60 years of age with generalized anxiety disorder (N=73) who were recruited from outpatient clinics at three sites. Participants received 12 weeks of open-label escitalopram and were then randomly assigned to one of four conditions: 16 weeks of escitalopram (10-20 mg/day) plus modular CBT, followed by 28 weeks of maintenance escitalopram; escitalopram alone, followed by maintenance escitalopram; escitalopram plus CBT, followed by pill placebo; and escitalopram alone, followed by placebo. RESULTS Escitalopram augmented with CBT increased response rates on the Penn State Worry Questionnaire but not on the Hamilton Anxiety Rating Scale compared with escitalopram alone. Both escitalopram and CBT prevented relapse compared with placebo. CONCLUSIONS This study demonstrates effective strategies for treatment of generalized anxiety disorder in older adults. The sequence of antidepressant medication augmented with CBT leads to worry reduction in the short-term. Continued medication prevents relapse, but for many individuals, CBT would allow sustained remission without requiring long-term pharmacotherapy.

Structure of Anxiety symptoms in urban children: competing factor models of the Revised Children's Manifest Anxiety Scale

The Revised Childrens Manifest Anxiety Scale (RCMAS; C. R. Reynolds & B. O. Richmond, 1985) is among the most widely used self-report measures of childrens anxiety. The authors compared its current empirically derived factor structure with theory-driven models derived from 8 experts on child anxiety using concept mapping. Confirmatory factor analyses compared models using data from 898 seventh graders in an urban public school system serving a high percentage of African Americans. The most parsimonious best-fitting model was an expert-derived model with factors reflecting anxious arousal, social evaluation-oversensitivity, worry, and a higher order factor. This model was theoretically meaningful, excluded items less relevant to anxiety, and was invariant across gender. Future research with the RCMAS should consider use of these dimensions. The combination of qualitative and quantitative methodology used in this study appeared to have considerable utility for refining measures.

The relation of anxiety, depression, and stress to binge eating behavior:

This study aimed to extend the literature by examining several psychological factors (i.e. depression, anxiety, and stress) in relation to binge eating. Data were collected via online surveys from a community sample of men and women of diverse backgrounds. The main study hypotheses were supported, indicating a unique relation between anxiety and binge eating, and between stress and binge eating, independent of the impact of depression. Gender differences are discussed. The results of this study suggest a need for a more detailed examination of negative affect in binge eating. Furthermore, the role of anxiety may be important for future research.