Michele M. Carter

Factor structure of the Anxiety Sensitivity Index among African American college students

This study examined the factor structure of the Anxiety Sensitivity Index (ASI) among African American college students. Confirmatory factor analysis indicated the 3-factor solution commonly found among other populations did not fit the data for African Americans. Although an exploratory factor analysis indicated the presence of a Mental Incapacitation factor, the Physical Concerns factor was divided into unsteady and cardiovascular concerns. Items typically comprising the Social factor were reflective of emotional controllability among African Americans. The ASI was also moderately correlated with measures of anxiety and depression providing only weak evidence of convergent and discriminate validity of the ASI for African Americans. Although support for the multidimensional nature of AS was found, the factor composition differs for African Americans.

Cognitive–Behavioral Group Therapy Versus a Wait-List Control in the Treatment of African American Women with Panic Disorder

This study examined the efficacy of group Panic Control Therapy (PCT; D. H. Barlow & M. G. Craske, 1994) for African Americans. Twenty-five African American women were assigned to either a treatment or wait-list control (WLC). Treatment was 11 group sessions, and wait-list participants did not receive any treatment for the same duration. At pretreatment, both groups were moderately anxious and depressed. At posttreatment, the PCT group experienced a significant reduction in panic frequency, avoidance behavior, state and trait anxiety, and anxiety sensitivity. There was no significant change on these variables for the WLC. There was a trend for change in depression among the PCT group only. On average, 54% of the treated group was classified as recovered, 17% as improved but not recovered, and 27% as unimproved. As many as 95% of the WLC were unimproved. The overall effect size of the study was comparable to that reported in previous studies of cognitive treatments incorporating interoceptive exposure with White Americans. These preliminary results suggest that CBT for panic is effective with African American women with panic disorder.

Parental bonding and anxiety: differences between African American and European American college students.

Empirical evidence suggests that early home environments characterized by low care and high overprotection are positively associated with the adult expression of anxiety. While available evidence supports this position for European Americans, there has been no examination of the relationship between perceived parental rearing practices and anxiety among African Americans despite the theoretical assertion that African American parenting environments may be characterized as somewhat more overprotective than European Americans. This study investigated the relationship between maternal rearing patterns and trait and state measures of anxiety and depression among a sample of 59 African American and 55 European American college students. Results indicated that both groups reported similar levels of anxiety, depression, perceived care, and perceived overprotection. European Americans exhibited the typical pattern of a negative relationship between anxiety, depression, and care and a positive relationship between anxiety and overprotection. African Americans evidenced a similar negative relationship between anxiety, depression, and care, but no relationship between anxiety, depression, and overprotection. Furthermore, specific aspects of ethnic identity (i.e., ethnic achievement, ethnic behaviors) were found to be negatively associated with measures of trait anxiety among African Americans but not European Americans.

The utility of the ASI factors in predicting response to voluntary hyperventilation among nonclinical participants.

Empirical research has demonstrated that the Anxiety Sensitivity Index (ASI) contains three separable factors and that ASI total scores are useful in predicting response to physiological challenge procedures. Little is known, however, of the predictive capability of the ASI factors. This study investigated the utility of the three factors of the ASI compared to ASI total scores and the STAI-T, a more general measure of trait anxiety, in predicting response to hyperventilation. As expected, the ASI total score was a significant predictor of response to hyperventilation, while the STAI-T was not. Using multiple regression, when the physical concerns factor was entered first, the social concerns and mental incapacitation factors of the ASI were not significant predictors of response to hyperventilation. Furthermore, when the physical concerns factor was entered into a regression equation followed by the remainder of the ASI items, only the physical concerns factor remained a significant predictor of response to hyperventilation. These results suggest that while response to physiological challenge procedures is predicted by ASI total scores, it may be best predicted by the physical concerns factor, and that the mental incapacitation and social concerns subscales do not play key roles in predicting response to physiological challenge procedures.

Biracial Self-Identification: Impact on Trait Anxiety, Social Anxiety, and Depression

Sixty-one Biracial participants were assessed on measures of depression, trait anxiety, and social anxiety to ascertain if their racial identity choice impacted their scores on these psychological measures. Societal pressure to identify as monoracial was also measured to determine if the various racial identity groups perceived these pressures differently and if these pressures were related to the reported quality of psychological functioning. Results indicated that a validated Biracial identity may serve as a protective factor for anxiety and depressive symptoms, whereas Biracial individuals who consider their race to be meaningless or fluid based on situational factors reported significantly higher levels of depression and trait anxiety symptoms than other Biracial individuals. The latter group also reported the least pressure from family to identify as monoracial. Societal pressure from peers to identify as monoracial was found to predict social anxiety and fear of negative evaluation among all Biracial participants.

Treating ethnic minority adults with anxiety disorders: current status and future recommendations.

The past three decades have witnessed an increase in the number of empirical investigations examining the phenomenology of anxiety and related conditions. There has also been an increase in efforts to understand differences that may exist between ethnic groups in the expression of the anxiety disorders. In addition, there is now substantial evidence that a variety of treatment approaches (most notably behavioral and cognitive behavioral) are efficacious in remediating anxiety. However, there continues to be comparatively few treatment outcome studies investigating the efficacy of anxiety treatments among minority populations. In this paper, we review the extant treatment outcome research for African American, Hispanic/Latino[a] American, Asian American, and Native Americans suffering with one of the anxiety disorders. We discuss some of the specific problems with the research in this area, and then provide specific recommendations for conducting treatment outcome research with minority populations in the future.

The Efficacy of Habituation in Decreasing Subjective Distress Among High Anxiety-Sensitive College Students

While there is mounting evidence that the concept of anxiety sensitivity (AS) is linked to the expression of anxiety (specifically, panic), there has been little research comparing the efficacy of interoceptive exposure alone with interoceptive exposure coupled with cognitive restructuring among high AS participants. The present investigation addressed this issue in a sample of high anxiety-sensitive college students (scores above 29 on the Anxiety Sensitivity Index). Participants were randomly assigned to receive either five consecutive trials of voluntary hyperventilation or five consecutive trials of hyperventilation with cognitive restructuring instructions. It was expected that while repeated hyperventilation would be associated with a significant reduction in self-reported anxiety, catastrophic cognitions, and somatic sensations across trials, the greatest reduction in symptoms would occur with the addition of cognitive restructuring. These predictions were partially supported. As expected, high AS participants evidenced significant decreases in anxiety symptoms when habituation was accompanied by cognitive restructuring. Contrary to predictions, however, interoceptive exposure alone was not effective in reducing anxious symptoms. These results suggest that brief habituation alone may not be an effective strategy for high AS participants and are discussed as providing further support for a cognitive model of anxiety.

Adapting Interpersonal Psychotherapy for the Prevention of Excessive Weight Gain in Rural African American Girls

OBJECTIVE To obtain focus group data regarding the perspectives of rural African American (AA) girls, parents/guardians, and community leaders on obesity, loss of control (LOC) eating, relationships, and interpersonal psychotherapy for the prevention of excessive weight gain (IPT-WG). METHODS 7 focus groups (N = 50 participants) were moderated and the transcripts analyzed by Westat researchers using widely accepted methods of qualitative and thematic analysis. A session was held with experts in health disparities to elucidate themes. RESULTS Participants understood LOC eating; however, they had culturally specific perceptions including usage of alternative terms. Relationships were highly valued, specifically those between mothers and daughters. IPT-WG program components generally resonated with participants, although modifications were recommended to respect parental roles. Experts interpreted focus group themes and discussed potential barriers and solutions to recruitment and participation. CONCLUSION Findings suggest that adapting IPT-WG may be acceptable to rural AA families. This research is the first step in developing a sustainable excessive weight gain and binge eating disorder prevention program for rural AA adolescents.

Obstetrician-gynecologists' decision making about the diagnosis of major depressive disorder and premenstrual dysphoric disorder

Major depressive disorder (MDD) is underdiagnosed and undertreated in ambulatory care settings [1–4] including gynecologic practices [5]. Far less is known about the diagnosis of Premenstrual Dysphoric Disorder (PMDD). Three hundred and thirty-five gynecologists responded to mailed questionnaires that used descriptive scenarios as analogues to clinical cases. Questionnaire recipients were randomly selected to receive either a MDD or PMDD version of the questionnaire. Respondents were less accurate when diagnosing MDD cases (48% accuracy; p = 0.526), than PMDD cases (80% accuracy; p < 0.001), but were significantly more confident about their probability ratings of MDD cases, t = 2.57, p < 0.02. Qualitative analysis suggested that less accurate MDD respondents did not prioritize case data according to DSM-IV criteria, whereas almost all PMDD respondents made use of valid reasoning strategies. Respondents did not take base rates into account when deciding about the probability of either affective disorder. Results imply that gynecologists employ cognitive strategies that result in accurate diagnostic judgments about PMDD, but overconfidence, lack of attention to DSM-IV criteria and base rate neglect could hinder clinical decisions about MDD, and may contribute to underdiagnosis of depression.

A Preliminary Examination of Trauma History, Locus of Control, and PTSD Symptom Severity in African American Women

Prior research has established a relationship between external locus of control and posttraumatic stress disorder (PTSD) symptom severity among Caucasians. There is also evidence that African Americans tend to exhibit an elevated external locus of control. However, the relationship between external control and PTSD symptom severity has not been examined among African American women. Using a sample of African American adult female volunteers who self-reported a history of child abuse and/or sexual or physical assault in adulthood, the present study sought to examine the relationships between trauma history, locus of control, and PTSD symptom severity. Participants in the child/adult trauma group reported fewer PTSD symptoms than those with a history of adult trauma only. Contrary to expectations, however, trauma history was not related to locus of control in this sample of African American women. It is possible that factors associated with African American socialization may serve as a buffer to the development or maintenance of PTSD.