Noortje Vriends

Fear conditioning in panic disorder: Enhanced resistance to extinction.

Enhanced conditionability has been proposed as a crucial factor in the etiology and maintenance of panic disorder (PD). To test this assumption, the authors of the current study examined the acquisition and extinction of conditioned responses to aversive stimuli in PD. Thirty-nine PD patients and 33 healthy control participants took part in a differential aversive conditioning experiment. A highly annoying but not painful electrical stimulus served as the unconditioned stimulus (US), and two neutral pictures were used as either the paired conditioned stimulus (CS+) or the unpaired conditioned stimulus (CS-). Results indicate that PD patients do not show larger conditioned responses during acquisition than control participants. However, in contrast to control participants, PD patients exhibited larger skin conductance responses to CS+ stimuli during extinction and maintained a more negative evaluation of them, as indicated by valence ratings obtained several times throughout the experiment. This suggests that PD patients show enhanced conditionability with respect to extinction.

The influence of state anxiety on the acquisition and extinction of fear

OBJECTIVE Fear conditionability has been found to be elevated in samples with high trait anxiety or anxiety disorders. Since these studies provide circumstantial evidence for a causal link between anxiety and conditionability we examined fear conditionability after experimental induction of anxiety in two experiments. METHOD In Experiment 1, 60 participants were randomized to one of two film conditions inducing an anxious or happy emotional state. They subsequently underwent a differential conditioning acquisition procedure. Two pictures of faces served as conditioned stimuli (CS+ and CS-), and an electric stimulus served as aversive unconditioned stimulus (US). In Experiment 2, after similar acquisition procedure as used in Experiment 1, 90 participants watched one of three films (anxious, neutral, happy) prior to an extinction procedure. In both studies, skin conductance response (SCR) served as measure of fearful responding. RESULTS Conditioning was successful in both studies. In Experiment 1, the anxious group exhibited decreased SCRs to both CS+ and CS- during acquisition. In Experiment 2, during extinction SCRs to both CSs were highest in the anxious group, intermediate in the neutral, and lowest in the happy group. DISCUSSION State anxiety did not enhance conditionability during acquisition or reduce the extinction procedure. However, individuals in an anxious state show less responding during fear learning, but more responding during unlearning. Thus, our results suggest that state anxiety changes the sensitivity with which individuals react to stimuli presented in different contexts.

Taijin kyofusho and social anxiety and their clinical relevance in indonesia and Switzerland.

Background: Taijin Kyofusho Scale (TKS) is an interpersonal fear to offend others and is defined by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a culturally bound syndrome that occurs in Japan and Korea. Recently, cases with TKS have also been recognized in other cultures. The present questionnaire study investigated self-report TKS symptoms and social anxiety symptoms, and their clinical relevance in an Indonesian and Swiss sample. It also investigated whether self-construal is associated with TKS and social anxiety, and if self-construal is a mediator of the expected association between cultural background and social anxiety and TKS symptoms. Method: 311 Indonesian and 349 Swiss university students filled out the Liebowitz Social Anxiety Scale, the Taijin Kyofusho Scale, the Self-Construal Scale, self-report social phobia DSM-IV criteria, and rated their wish for professional help to deal with social fears. Results: TKS and social anxiety symptoms were higher in the Indonesian than the Swiss sample. TKS symptoms were associated with clinical relevance in Indonesia, whereas in Switzerland only social anxiety symptoms were associated with clinical relevance. Independent self-construal was negatively associated and interdependent self-construal was positively associated with TKS and social anxiety symptoms. Interdependent self-construal mediated the association between cultural background and these symptoms. Discussion: TKS might be a clinically relevant syndrome in all individuals or cultures with an interdependent self-construal or less independent self-construal. The proposal to include the fear of offending others in the DSM-V criteria of social phobia is supported by the present findings.

Community Violence Exposure and Conduct Problems in Children and Adolescents with Conduct Disorder and Healthy Controls

Exposure to community violence through witnessing or being directly victimized has been associated with conduct problems in a range of studies. However, the relationship between community violence exposure (CVE) and conduct problems has never been studied separately in healthy individuals and individuals with conduct disorder (CD). Therefore, it is not clear whether the association between CVE and conduct problems is due to confounding factors, because those with high conduct problems also tend to live in more violent neighborhoods, i.e., an ecological fallacy. Hence, the aim of the present study was: (1) to investigate whether the association between recent CVE and current conduct problems holds true for healthy controls as well as adolescents with a diagnosis of CD; (2) to examine whether the association is stable in both groups when including effects of aggression subtypes (proactive/reactive aggression), age, gender, site and socioeconomic status (SES); and (3) to test whether proactive or reactive aggression mediate the link between CVE and conduct problems. Data from 1178 children and adolescents (62% female; 44% CD) aged between 9 years and 18 years from seven European countries were analyzed. Conduct problems were assessed using the Kiddie-Schedule of Affective Disorders and Schizophrenia diagnostic interview. Information about CVE and aggression subtypes was obtained using self-report questionnaires (Social and Health Assessment and Reactive-Proactive aggression Questionnaire (RPQ), respectively). The association between witnessing community violence and conduct problems was significant in both groups (adolescents with CD and healthy controls). The association was also stable after examining the mediating effects of aggression subtypes while including moderating effects of age, gender and SES and controlling for effects of site in both groups. There were no clear differences between the groups in the strength of the association between witnessing violence and conduct problems. However, we found evidence for a ceiling effect, i.e., individuals with very high levels of conduct problems could not show a further increase if exposed to CVE and vice versa. Results indicate that there was no evidence for an ecological fallacy being the primary cause of the association, i.e., CVE must be considered a valid risk factor in the etiology of CD.

Predictors of specific phobia in young women: a prospective community study.

Potential predictors of incidence of specific phobia were investigated within the conceptual framework of the vulnerability-stress model. At two time points separated by approximately 17 months, a community sample of 1261 German women (18-25 years of age) completed a structured interview. A broad range of potential stress- and vulnerability-related predictors was recorded at initial assessment. The strongest predictors of incidence were: high levels of preexisting psychopathology, a lack of coping skills, and a negative cognitive style. Assessing individual differences in stress and vulnerability thus seem to offer additional information about etiology of specific phobia beyond traditional learning theory. Incorporating the role of these risk factors may be useful for identifying individuals who are at increased risk and improving measures of prevention.

Does self-focused attention in social anxiety depend on self-construal? Evidence from a probe detection paradigm

Cognitive models of social anxiety disorder propose self-focused attention as a key maintenance factor of the disorder. However, whether this holds true for different cultural contexts has not been investigated. The present experiment investigated the influence of self-construal (interdependent versus independent) on self-focused attention in high and low socially anxious individuals. Eighty-seven participants, divided into high versus low socially anxious and interdependent versus independent self-construal, performed a self-focused attention probe detection paradigm. A reaction time metric relating to attention deployment on the self versus the other served as an index of self-focused attention. In individuals with an interdependent self-construal those who are highly socially anxious showed decreased self-focused attention compared to those who are low socially anxious. In individuals with an independent self-construal the effect of social anxiety was less strong and in the opposite direction (but congruent with cognitive models). These results indicate that self-focused attention in social anxiety depends on self-construal. These findings implicate different therapies for people with social anxiety disorder, depending on their self-construal.

WAYS OF ACQUIRING FLYING PHOBIA

The few studies that have explored how flying phobia is acquired have produced contradictory results. We hypothesized that classical conditioning plays a role in acquiring flying phobia and investigated if vicarious (model) learning, informational learning through media, and experiencing stressful life events at the time of onset of phobia also play a role.

Humanistic outcomes and patient acceptance of the pharmacist-led medication review “Polymedication Check” in primary care in Switzerland: a prospective randomized controlled trial

Background Since 2010, Swiss pharmacists have been offering their patients a Polymedication Check (PMC), a new cognitive pharmacy service in the form of a medication review for patients taking ≥4 prescribed medicines for a period >3 months. While a first publication of this project reported on the impact of the PMC on patients’ adherence, the present paper focuses on humanistic outcomes. Methods This randomized controlled trial was conducted in 54 Swiss community pharmacies. After recruitment, the intervention group underwent a PMC in the pharmacy (T-0) and 28 weeks after T-0 (T-28), while the control group did not receive the PMC until 28 weeks after the study started (T-28). A clinical psychologist, blinded to the intervention, interviewed the patients 2 weeks (T-2) and 16 weeks (T-16) after T-0. Interviewer and patient both rated patient’s knowledge of own medicines use. Furthermore, patients reported satisfaction with their pharmacy and appraisal of their medicines use. The availability of a written medication plan was assessed at T-16. Acceptance of the service was measured using a patient’s self-report questionnaire at T-28. Results General linear model analysis for knowledge about medicines revealed a significant effect on the factor “group” (P=5.86, p=0.016), indicating that the intervention group had higher ratings for knowledge about their medication at T-2 and T-16 compared to controls. The majority (83%) of patients judged the counseling by the pharmacist as being helpful for their daily medication management. Availability of a written medication plan was comparable in both groups (52.5% vs 52.7%, p>0.05). Conclusion For the first time, the benefits of a complex pharmacist-led intervention were evaluated in Swiss primary care with a randomized controlled trial. The PMC increased patients’ subjective knowledge of their medicines compared to no medication review. The effect remained sustainable over time. Recommendations resulting from the pharmacist-led service were highly appreciated by the patients.