Randi E. McCabe

Psychometric Properties of the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA): Comparison to the State-Trait Anxiety Inventory (STAI)

The State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA; M. J. Ree, C. MacLeod, D. French, & V. Locke, 2000) was designed to assess cognitive and somatic symptoms of anxiety as they pertain to ones mood in the moment (state) and in general (trait). This study extended the previous psychometric findings to a clinical sample and validated the STICSA against a well-published measure of anxiety, the State-Trait Anxiety Inventory (STAI; C. D. Spielberger, 1983). Patients (N=567) at an anxiety disorders clinic were administered a battery of questionnaires. The results of confirmatory factor analyses (Bentler-Bonnett nonnormed fit index, comparative fit index, and Bollen fit index>.90; root-mean-square error of approximation<.05); convergent and discriminant validity analyses; and group comparisons supported the reliability and validity of the STICSA as a measure of state and trait cognitive and somatic anxiety. In addition, compared with the STAI (anxiety: rs</=.52; depression: rs>/=.64), the STICSA was more strongly correlated with another measure of anxiety (rs>/=.67) and was less strongly correlated with a measure of depression (rs</=.61). These findings suggest that the STICSA may be a purer measure of anxiety symptomatology than is the STAI.

Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression.

Intolerance of uncertainty (IU) - a dispositional characteristic resulting from negative beliefs about uncertainty and its implications - may be an important construct in anxiety disorders and depression. Despite the potential importance of IU, clinical data on the construct remains relatively scant and focused on generalized anxiety disorder and obsessive-compulsive disorder. The present study systematically investigated IU, as measured by the Intolerance of Uncertainty Scale-12 (IUS-12), across groups diagnosed with anxiety disorders (i.e., social anxiety disorder, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder) or depression (clinical sample: n=376; 61% women), as well as undergraduate (n=428; 76% women) and community samples (n=571; 67% women). Analysis of variance revealed only one statistically significant difference in IUS-12 scores across diagnostic groups in the clinical sample; specifically, people with social anxiety disorder reported higher scores (p<.01; η(2)=.03) than people with panic disorder. People diagnosed with an anxiety disorder or depression reported significantly and substantially higher IUS-12 scores relative to community and undergraduate samples. Furthermore, IUS-12 score distributions were similar across diagnostic groups as demonstrated by Kernel density estimations, with the exception of panic disorder, which may have a relatively flat distribution of IU. Response patterns were invariant across diagnostic groups as demonstrated by multi-group confirmatory factor analyses, but varied between clinical and nonclinical samples. Overall, the findings suggest IU may serve as an important transdiagnostic feature across anxiety disorders and depression. In addition, robust support was found for the proposed 2-factor model of the IUS-12. Comprehensive findings, implications, and future research directions are discussed.

Preliminary examination of the relationship between anxiety disorders in adults and self-reported history of teasing or bullying experiences

This preliminary study examined the relationship between anxiety disorders and self-reported history of teasing or bullying experiences, comparing individuals with social phobia, obsessive compulsive disorder, and panic disorder with or without agoraphobia. Given that aversive conditioning experiences, such as severe teasing, have been proposed to play a role in the development of social phobia and that the core feature of social phobia is a fear of social situations in which a person may be embarrassed or humiliated, we hypothesized that the social phobia group would have a higher rate of self-reported teasing history than would the obsessive compulsive disorder or panic disorder groups. Consistent with this hypothesis, a relationship between reported history of teasing and diagnosis was found. A significantly greater percentage of participants in the social phobia group (92%) reported a history of severe teasing experiences compared with the obsessive compulsive disorder (50%) and panic disorder (35%) groups. History of teasing experiences was also significantly related to an earlier age of onset for all 3 anxiety disorders, and to a greater number of self-reported additional problems in childhood. These findings suggest further directions for research in this area and highlight the significant link between perceptions of teasing in childhood and social phobia.

Frequency and severity of the symptoms of irritable bowel syndrome across the anxiety disorders and depression.

High rates of irritable bowel syndrome (IBS) symptoms have been reported in individuals diagnosed with anxiety and depressive disorders. However, most studies have investigated these relations in a single disorder, rather than a heterogeneous group of patients, thereby not allowing for comparisons across anxiety disorders and depression, or for considering the effects of comorbidity. Thus, the present study investigated the symptoms of IBS in a diverse group of patients (N=357) by administering questionnaires and a diagnostic interview. A high frequency of IBS symptoms was found in patients with panic disorder, generalized anxiety disorder, and major depressive disorder. However, the frequency of IBS symptoms in patients with social anxiety disorder, specific phobia, and obsessive-compulsive disorder was comparable to rates found in community samples. In addition, anxiety sensitivity and illness attitudes and intrusiveness were predictive of elevated IBS symptomatology. Together, these findings emphasize the role physiological symptoms of anxiety and worry in the co-occurrence of the anxiety disorders and IBS.

Addressing revisions to the Brief Fear of Negative Evaluation scale: measuring fear of negative evaluation across anxiety and mood disorders.

The fear of negative evaluation (FNE) represents a fundamental component of social anxiety and social anxiety disorder (SAD) within modern cognitive-behavioral models (Clark & Wells, 1995; Rapee & Heimberg, 1997). As such, access to comprehensive psychometrics for measures of FNE is an important component of thorough clinical and research efforts. Among the most popular measures of FNE have been variations of the 12-item Brief Fear of Negative Evaluation (BFNE) scale (Leary, 1983). There are currently three versions of the BFNE based on two psychometric studies (i.e., two 8-item variants and a 12-item variant). There is still substantial debate regarding which of the three alternatives should be used by researchers and clinicians. Normative data for each of the three alternatives are not available across samples of individuals with diagnosed anxiety and mood disorders; moreover, there has been no comparative assessment of responses for such samples. The present investigation was to provide more definitive recommendations about the three alternatives, to provide normative clinical data, and to explore differences in FNE endorsement across anxiety and mood disorders. Clinical participants included 381 individuals (60% women; age M=35.61, SD=12.49) from an established anxiety treatment and research center. Diagnoses included those with a principal diagnosis of SAD (32%), those with a diagnosis of SAD as an additional disorder (24%), those without a diagnosis of SAD (41%), and those with features of SAD (3%). Results of descriptive analyses, factor analyses, analysis of variance, and receiver operating curves demonstrated that the 12-item variant of the BFNE was inferior or comparable to the two 8-item variants. FNE scores were consistently higher among all participants with a diagnosis of SAD (either principal or additional) relative to all other diagnostic groups (p<.05). Accordingly, the current evidence, as well as parsimony and previous research, supports the utility of the 8-item variant that includes only the original straightforwardly worded items from the BFNE. Comprehensive findings, implications, and future research directions are discussed.

Consistency between self-report and clinician-administered versions of the Yale-Brown Obsessive-Compulsive Scale.

BACKGROUND Preliminary efforts to demonstrate the utility of a self-rated version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have been promising; however, earlier reports are based on small clinical samples. The objective of the present study was to evaluate the level of agreement between the clinician-administered Y-BOCS and a self-report version. METHODS Participants included 86 individuals with a principal diagnosis of obsessive-compulsive disorder (OCD). All participants were given the self-report version of the Y-BOCS to complete offsite and instructed to return it at a second assessment session (within a 2-week time frame), at which time a trained and experienced clinician administered the Y-BOCS interview. RESULTS The two versions were moderately correlated with the highest correlation observed for the Compulsions subscale. Comparison of scores for individual items revealed several inconsistencies between the two measures: level of agreement was low for resistance items, and the interview version generated higher compulsion severity ratings. CONCLUSIONS The study provided moderate support for the convergence of the self-report and clinician-administered version of the Y-BOCS, however, important difference were detected between the two assessment methods.

Frontal EEG asymmetry and symptom response to cognitive behavioral therapy in patients with social anxiety disorder

Although previous studies have shown that socially anxious individuals exhibit greater relative right frontal electroencephalogram (EEG) activity at rest, no studies have investigated whether improvements in symptoms as a result of treatment are associated with concomitant changes in resting brain activity. Regional EEG activity was measured at rest in 23 patients with social anxiety disorder (SAD) before and after cognitive behavioral therapy (CBT). Results indicated that patients shifted significantly from greater relative right to greater relative left resting frontal brain activity from pre- to posttreatment. Greater left frontal EEG activity at pretreatment predicted greater reduction in social anxiety from pre- to posttreatment and lower posttreatment social anxiety after accounting for pretreatment symptoms. These relations were specific to the frontal alpha EEG asymmetry metric. These preliminary findings suggest that resting frontal EEG asymmetry may be a predictor of symptom change and endstate functioning in SAD patients who undergo efficacious psychological treatment.

Pain-related anxiety and anxiety sensitivity across anxiety and depressive disorders

Fear-anxiety-avoidance models posit pain-related anxiety and anxiety sensitivity as important contributing variables in the development and maintenance of chronic musculoskeletal pain [Asmundson, G. J. G, Vlaeyen, J. W. S., & Crombez, G. (Eds.). (2004). Understanding and treating fear of pain. New York: Oxford University Press]. Emerging evidence also suggests that pain-related anxiety may be a diathesis for many other emotional disorders [Asmundson, G. J. G., & Carleton, R. N. (2005). Fear of pain is elevated in adults with co-occurring trauma-related stress and social anxiety symptoms. Cognitive Behaviour Therapy, 34, 248-255; Asmundson, G. J. G., & Carleton, R. N. (2008). Fear of pain. In: M. M. Antony & M. B. Stein (Eds.), Handbook of anxiety and the anxiety disorders (pp. 551-561). New York: Oxford University Press] and appears to share several elements in common with other fears (e.g., anxiety sensitivity, illness/injury sensitivity, fear of negative evaluation) as described by Reiss [Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11, 141-153] and Taylor [Taylor, S. (1993). The structure of fundamental fears. Journal of Behavior Therapy and Experimental Psychiatry, 24, 289-299]. The purpose of the present investigation was to assess self-reported levels of pain-related anxiety [Pain Anxiety Symptoms Scale-Short Form; PASS-20; McCracken, L. M., & Dhingra, L. (2002). A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Research and Management, 7, 45-50] across several anxiety and depressive disorders and to compare those levels to non-clinical and chronic pain samples. Participants consisted of a clinical sample (n=418; 63% women) with principal diagnoses of a depressive disorder (DD; n=22), panic disorder (PD; n=114), social anxiety disorder (SAD; n=136), obsessive-compulsive disorder (OCD; n=86), generalized anxiety disorder (GAD; n=46), or specific phobia (n=14). Secondary group comparisons were made with a community sample as well as with published data from a treatment-seeking chronic pain sample [McCracken, L. M., & Dhingra, L. (2002). A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Research and Management, 7, 45-50]. Results suggest that pain-related anxiety is generally comparable across anxiety and depressive disorders; however, pain-related anxiety was typically higher (p<.01) in individuals with anxiety and depressive disorders relative to a community sample, but comparable to or lower than a chronic pain sample. Results imply that pain-related anxiety may indeed be a construct independent of other fundamental fears, warranting subsequent hierarchical investigations and consideration for inclusion in treatments of anxiety disorders. Additional implications and directions for future research are discussed.

The relationship between anxiety disorders in adults and recalled childhood teasing

This study investigated the relationship between retrospective accounts of childhood teasing and anxiety disorders as well as the relationship between experiences of teasing and more global psychological well-being. Participants (N=377) with social anxiety disorder (SAD), obsessive compulsive disorder (OCD), or panic disorder with or without agoraphobia (PD) were compared on levels of self-reported teasing history using the Teasing Questionnaire-Revised (TQ-R; Storch et al., 2004). Teasing frequency scores were higher for the SAD group compared to both PD and OCD groups. Across all groups, teasing scores were significantly related to increased social anxiety, depression, stress, and greater impairment in functioning. Teasing frequency accounted for unique variance in severity of SAD symptoms even after controlling for concurrent mood, anxiety and stress. These results support and extend previous findings linking childhood teasing to anxiety disorders in adulthood.

Help, Not Harm: Psychological Foundation for a Nondieting Approach Toward Health

This article reviews the literature on the psychological consequences of dieting. In particular, the authors examine the impact of dieting on mood, self-esteem, cognition, and eating behavior. The famous Keys study of starvation is discussed in relations to impaired concentration, food preoccupation, negative affect, and binge eating behavior. Overall, the literature indicates that dieting has a negative impact on psychological well-being. As a result, alternative nondieting approaches toward eating are presented and recommended to promote psychological health.