Meredith E. Coles

Robust Dimensions of Anxiety Sensitivity: Development and Initial Validation of the Anxiety Sensitivity Index-3.

Accumulating evidence suggests that anxiety sensitivity (fear of arousal-related sensations) plays an important role in many clinical conditions, particularly anxiety disorders. Research has increasingly focused on how the basic dimensions of anxiety sensitivity are related to various forms of psychopathology. Such work has been hampered because the original measure--the Anxiety Sensitivity Index (ASI)--was not designed to be multidimensional. Subsequently developed multidimensional measures have unstable factor structures or measure only a subset of the most widely replicated factors. Therefore, the authors developed, via factor analysis of responses from U.S. and Canadian nonclinical participants (n=2,361), an 18-item measure, the ASI-3, which assesses the 3 factors best replicated in previous research: Physical, Cognitive, and Social Concerns. Factorial validity of the ASI-3 was supported by confirmatory factor analyses of 6 replication samples, including nonclinical samples from the United States and Canada, France, Mexico, the Netherlands, and Spain (n=4,494) and a clinical sample from the United States and Canada (n=390). The ASI-3 displayed generally good performance on other indices of reliability and validity, along with evidence of improved psychometric properties over the original ASI.

The Liebowitz Social Anxiety Scale: a comparison of the psychometric properties of self-report and clinician-administered formats

BACKGROUNDnThe clinician-administered version of the Liebowitz Social Anxiety Scale (LSAS-CA) is a commonly used assessment device for the evaluation of social anxiety disorder and has been shown to have strong psychometric characteristics. Because of its apparently straightforward rating format and potential savings in time and effort, interest in the use of the LSAS as a self-report (LSAS-SR) measure has increased, and the LSAS-SR has been used in a number of studies. However, the psychometric properties of the LSAS-SR have not been well established.nnnMETHODSnThis study examined the psychometric properties of the LSAS-SR in comparison to the LSAS-CA in a sample of 99 individuals with a primary diagnosis of social anxiety disorder and 53 individuals with no current psychiatric disorder.nnnRESULTSnThere was little difference between the two versions of the LSAS on any scale or subscale score. Both forms were internally consistent and the subscale intercorrelations for the two forms were essentially identical. Correlations of each LSAS-SR index with its LSAS-CA counterpart were all highly significant. Finally, the convergent and discriminant validity of the two forms of the LSAS was shown to be strong.nnnCONCLUSIONnResults of this study suggest that the self-report version of the LSAS compares well to the clinician-administered version and may be validly employed in the assessment of social anxiety disorder.

Negative interpretation bias in social phobia.

We examined the hypothesis that, compared to non-anxious controls (NACs) and individuals with other anxiety disorders (e.g., individuals with obsessive compulsive disorder; OCs), individuals with generalized social phobia (GSPs) would tend to interpret ambiguous social scenarios as negative when provided with various alternative interpretations. Participants were presented with 22 ambiguous scenarios each followed by three possible interpretations: positive, negative, and neutral. Fifteen scenarios were socially relevant and the remaining 7 were nonsocially relevant. Participants were asked to rank order the three interpretations according to the likelihood that each would come to their mind and to a typical persons mind in similar situations. Results revealed that GSPs (but not NACs or OCs) tended to choose a negative interpretation for ambiguous social scenarios even when a positive interpretation was available. This bias was specific to self-relevant scenarios. These results support the hypothesis that a specific negative interpretation bias may be involved in the maintenance of social phobia.

Memory biases in the anxiety disorders: Current status

Information-processing models of emotional disorders suggest that anxious individuals may be characterized by a memory bias for threat-relevant information. This paper reviews and synthesizes evidence for explicit (conscious) and implicit (unconscious) memory biases in the anxiety disorders. Our review suggests variations among the anxiety disorders for explicit memory biases. Specifically, there is support for explicit memory biases for threat-relevant information in panic disorder (PD), particularly when information has been deeply encoded, but not in social phobia (SP) or generalized anxiety disorder (GAD). The few available studies suggest the presence of explicit memory biases in posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), but further research is needed. In contrast, some degree of support for implicit memory biases has been demonstrated for each of the anxiety disorders. Inconsistencies in the existing literature, topics worthy of future research attention, and directions for revising existing information-processing models of anxiety are discussed.

“Not just right experiences”: perfectionism, obsessive–compulsive features and general psychopathology

Individuals with obsessive-compulsive disorder (OCD) frequently report uncomfortable sensations of things not being just right (not just right experiences; NJREs) and a need to ritualize until they quiet these sensations. However, very little work has been conducted to empirically examine the nature and characteristics of this phenomenon. In this paper, we present two studies that systematically examine NJREs in large undergraduate samples. In Study 1, NJREs were shown to be related to both OCD features and maladaptive domains of perfectionism. In Study 2, NJREs were again significantly related to OCD features. Further, NJREs were shown to have particularly strong relationships with specific OCD symptom clusters (e.g., checking, ordering). Finally, NJREs were significantly more strongly correlated with features of OCD than symptoms from other domains of psychopathology (e.g., social anxiety, trait anxiety, worry, depression). General conclusions are drawn, and future directions are discussed.

The relationship between memories for childhood teasing and anxiety and depression in adulthood.

This study explored the relationship between memories for childhood teasing and anxiety and depression in adulthood. A Teasing Questionnaire (TQ) was developed that measured the degree to which people recall having been teased about 20 different topics during childhood. The TQ was completed by a sample of 514 undergraduates who also completed established measures of anxiety and depression. A one-factor model best accounted for the variance in TQ scores, and the total score was shown to have strong internal consistency. Scores on the TQ were significantly and positively related to scores on measures of current depression, trait anxiety, social anxiety, and anxiety sensitivity. Tests of dependent correlations showed that remembering having been teased during childhood was not differentially related to depression and trait anxiety in adulthood. However, differential relationships between reports of teasing and specific forms of anxiety were shown. Limitations of the study were discussed, as were suggestions for future research in the more general arena of childhood peer relations and adult psychopathology.

Hoarding behaviors in a large college sample

Hoarding behaviors occur in many clinical syndromes but are most commonly linked to obsessive compulsive disorder. Surprisingly little empirical work has examined the nature of hoarding behaviors despite their association with significant distress and impairment. The current study examined hoarding in 563 unselected college students. Using principal components analysis, we identified four domains of hoarding behaviors as measured by the 26-item Saving Inventory-Revised: Difficulty Discarding, Acquisition Problems, Clutter, and Interference/Distress. All four domains and total hoarding behaviors were strongly related to hoarding beliefs and to obsessive compulsive (OC) symptoms. Hoarding behaviors were most strongly correlated with subscales of an OC disorder (OCD) measure assessing hoarding and obsessions and least strongly correlated with the washing subscale. Hoarding behaviors also showed significant, but more modest, correlations with social anxiety, depressive symptoms, and worry. However, worry was not found to contribute unique variance to the prediction of hoarding behaviors. Of greatest note, hoarding behaviors showed a surprisingly strong relationship with anxiety sensitivity, similar in magnitude to the relationship between hoarding and OCD symptoms. Results are interpreted and lines of future research are proposed, with particular emphasis on further elucidating the relationship between hoarding behaviors and anxiety sensitivity.

Effects of varying levels of anxiety within social situations: relationship to memory perspective and attributions in social phobia.

Cognitive-behavioral theorists (Clark & Wells, 1995: Clark, D. M. & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford Press; Rapee & Heimberg, 1997: Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756.) propose that individuals with social phobia form mental images of themselves as if from an external point of view. Research by Wells and colleagues has shown that, when recalling anxiety-provoking social situations, individuals with social phobia are more likely to take an observer perspective (seeing oneself as if from an external point of view) whereas control subjects are more likely to take a field perspective (as if looking out through ones own eyes). Furthermore, this pattern is specific to social events, as both groups recall non-social events from a field perspective (see Wells, Clark & Ahmad, 1998: Wells, A., Clark, D. M., & Ahmad, S. (1998). How do I look with my minds eye: perspective taking in social phobic imagery. Behaviour Research and Therapy, 36, 631-634; Wells & Papageorigou, 1999: Wells, A. & Papageorgiou, C. (1999). The observer perspective: Biased imagery in social phobia, agoraphobia, and blood/injury phobia. Behaviour Research and Therapy, 37, 653-658). In the current study, individuals with social phobia took more of an observer perspective than non-anxious controls when recalling high anxiety social situations. However, both groups took a predominantly field perspective for memories of medium or low anxiety social situations. As memory perspective has also been shown to be related to causal attributions, we examined this relationship in our sample. Memories of low, medium, and high anxiety social situations were differentially related to attributions for each group. Patients attributions for their performance became more internal, stable, and global as the anxiety level of the situation increased, while the attributions of control subjects showed the opposite pattern.

Implicit memory bias for threat-relevant information in individuals with generalized social phobia.

The authors used a noise judgment task to investigate implicit memory bias for threat in individuals with generalized social phobia (GSP). Participants first heard neutral sentences (e.g., The manual tells you how to set up the tent.) and social-threat sentences (e.g., The classmate asks you to go for drinks.). Implicit memory for these sentences was then tested by asking participants to rate the volume of noise accompanying the presentation of these old sentences intermixed with new sentences that had not been previously presented. Implicit memory for old sentences is revealed when participants rate the noise accompanying old sentences as less loud than the noise accompanying new sentences. Those with GSP demonstrated an implicit memory bias for social-threat sentences, whereas controls did not. This differential priming effect suggests that information about threat may be automatically accessed in GSP.

Considerations in the use of exposure with children

Exposure interventions, both imaginal and in vivo, are an integral part of cognitive behavioral treatments for anxiety disorders and have been found to be efficacious when used to treat various fears and phobias. Although most of the literature has focused on the use of exposure with adults, there is increasing interest in the use of these techniques with anxious children and adolescents. The premise underlying exposures efficacy is that although it is initially uncomfortable, anxiety will eventually diminish and erroneous cognitions will be disconfirmed when one is exposed repeatedly to a feared stimulus in the absence of the feared negative consequence. In this article the use of exposure techniques with children and adolescents will be discussed, focusing particularly on increasing the developmental sensitivity of these techniques to maximize their effects for younger patients. Various exposure techniques in younger patients will be described, core principles of exposure treatment for anxious children will be delineated, and application for specific pediatric anxiety disorders will be discussed.