Rolf G. Jacob

Anxiety sensitivity: An examination of theoretical and methodological issues

Abstract The construct of anxiety sensitivity (AS) has occupied an increasingly important place in theorizing and research on anxiety and anxiety disorders. Although a number of recent studies have provided support for the construct validity of the principal operationalization of AS, the Anxiety Sensitivity Index (ASI), the relation of the AS construct and the ASI to trait anxiety continues to be a source of controversy. Key issues in the AS-trait anxiety debate include the assimilative nature of traits and the concept of incremental validity. Recent research on AS lends some support to the claim that trait anxiety cannot fully account for AS findings. Important areas for future AS research include (1) demonstrating that AS is a risk factor for panic disorder and related conditions, lather than simply a consequence of these conditions, (2) developing and utilizing multiple operationalizations of constructs, (3) minimizing the impact of potentially inapplicable items, (4) testing for interactions between AS and other variables, and (5) testing hierarchical factor models that allow trait anxiety and AS to coexist as higher- and lower-order factors, respectively. Researchers in this area will need to develop alternative measures of the AS construct, recognize the distinction between different levels of trait specificity, clarify a number of theoretical issues relevant to the AS construct, and continue to subject predictions to stringent theoretical risks.

Social Phobia: A Comparison of Behavior Therapy and Atenolol.

Seventy-two social phobics were randomly assigned to behavioral (flooding) or drug treatment with atenolol or placebo. Treatment was administered over a 3-month period of time, and duration of treatment effects was determined at a 6-month follow-up assessment. Multiple measures of outcome were used, including self-report, clinician ratings (including assessment by independent evaluators), behavioral assessment, and performance on composite indexes. The results indicated that flooding consistently was superior to placebo, whereas atenolol was not. Flooding also was superior to atenolol on behavioral measures and composite indexes. Those subjects who improved during treatment maintained gains at the 6-month follow-up regardless of whether they received flooding or atenolol. The variability of outcome on different measures in social phobia research is discussed, and the need for broad-based treatment strategies to address the pervasive deficits associated with social phobia is noted.

The Effect of Nicotine on Energy Expenditure during Light Physical Activity

The metabolic effects of nicotine have been implicated in the relation between smoking and lower body weight. This study examined whether the nicotine-induced increase in the metabolic rate observed at rest is also present during physical activity. We compared the energy expenditure of 10 male smokers receiving nicotine (15 micrograms per kilogram of body weight) with that of 10 male smokers receiving placebo on two occasions, each including a period of rest and a period of exercise on a modified bicycle ergometer at workloads designed to simulate and standardize light daily activity. All had abstained from cigarette smoking the night before the study. The excess energy expenditure attributable to nicotine was more than twice as great during exercise (difference between groups, 0.51 kJ per kilogram per hour, or 12.1 percent of the metabolic rate at rest; P less than 0.001) than during rest (0.23 kJ per kilogram per hour, or 5.3 percent of the metabolic rate at rest; P less than 0.05). In contrast, the expenditure was not affected by placebo during exercise or rest in the smokers or in a comparison group of 10 non-smokers, indicating that smoking status has no long-term metabolic effect in the absence of short-term nicotine intake. We conclude that the relatively small metabolic effect of nicotine when the subject is at rest is enhanced during light exercise. Our data also suggest that the weight gain that often follows smoking cessation may be influenced not only by nicotine intake but also by the level of physical activity a smoker typically engages in while smoking.

A clinical taxonomy of dizziness and anxiety in the otoneurological setting.

Dizziness can be associated with otologic, neurologic, medical, and psychiatric conditions. This paper focuses on the interface between otologic and psychiatric conditions. Because dizziness often is situation specific, concepts of space and motion sensitivity (SMS), space and motion discomfort (SMD), and space and motion phobia (SMP) are needed to understand the interface. We present a framework involving several categories of interactions between balance and psychiatric disorders. The first category is that of dizziness caused by psychiatric disorder (psychiatric dizziness), including hyperventilation-induced dizziness during panic attacks. The second category involves chance cooccurrence of a psychiatric disorder and a balance disorder in the same patient. The third category involves problematic coping with balance symptoms (psychiatric overlay). The fourth category provides psychological explanations for the relationship between anxiety and balance disorders, including somatopsychic and psychosomatic relationships. The final category, neurological linkage, focuses on the overlap in the neurological circuitry involved in balance disorders and anxiety disorders.

Migraine–anxiety related dizziness (MARD): a new disorder?

Dizziness is a common complaint that can result from abnormalities of the vestibular apparatus of the inner ear and of those portions of the central nervous system (CNS) that process information from the peripheral vestibular system and other senses, particularly vision and somatosensation. Recently, two CNS disorders, migraine and anxiety, have been recognised as being commonly associated with dizziness.1,2 These associations may be an expression of an aetiological relationship, for example, dizziness caused by migraine, or dizziness caused by anxiety; alternatively, migraine or anxiety may influence the presentation of a balance disorder. For example, chronic dizziness may become more disabling during the added stress of a migraine headache or panic attack. In addition, dizziness occurs comorbidly with both migraine headache and anxiety disorders.3,4 Finally, there is increased comorbidity between anxiety and migraine.5 Thus, it is not surprising that some patients with dizziness may suffer from a combination of a balance disorder, migraine, and an anxiety disorder, a symptom complex that we propose to name migraine−anxiety related dizziness (MARD) (fig 1). The general recognition of MARD may be limited because of the fragmented nature of our healthcare system, where specialists in one field, such as psychiatry or neurology, fail to recognise phenomena known to specialists in other fields, such as otoneurology. Figure 1  Venn diagram of the interfaces among migraine, anxiety, and balance disorders. The central sector, which denotes the three way interface, represents an hypothesised new ailment, migraine−anxiety related dizziness (MARD). This editorial will focus on the pathophysiology and clinical issues relating to MARD, including the interfaces among balance disorders, migraine, and anxiety. We use current epidemiological data and studies of pathogenesis to develop comorbidity models. These models serve as hypotheses that may lead to possible treatment options for many patients with dizziness, including those with MARD. …

Assessment of social phobia: Reliability of an impromptu speech task☆

Abstract As part of a pretreatment assessment battery, social phobics were required to participate in two impromptu speech tasks, scheduled one week apart. The reliability of psysiological, cognitive, and behavioral variables collected during the speech was assessed. The results indicated that the data collected during this task were consistent across the two assessment periods, indicating the reliability of this procedure for the behavioral assessment of social phobia. The results are discussed in terms of the usefulness of this procedure in assessing various dimensions of social phobia.

Social phobia: Axis I and II correlates.

The presence of Axis I and Axis II disorders in 71 social phobic patients was examined. Generalized anxiety disorder was the most common secondary Axis I disorder, followed by simple phobia. Avoidant personality disorder and obsessive-compulsive personality disorder were the most common Axis II diagnoses, and 88% of the sample exhibited features of these 2 personality styles. Subjects with additional Axis I diagnoses were more anxious and depressed than those with no additional Axis I disorder. Social phobics with additional Axis II disorders were more depressed but not more anxious than those with no Axis II diagnosis. Furthermore, those with an additional Axis I disorder had higher scores on measures of neuroticism, interpersonal sensitivity, and agoraphobia. The prevalence and impact of additional Axis I and II disorders on the etiology, maintenance, and treatment outcome for persons with social phobia are discussed.

Background and history of the interface between anxiety and vertigo

The comorbidity of vertigo and anxiety has been an integral component of the medical literature since antiquity. In the works of Plato, the same terms were used in the context of vertigo, inebriation, height vertigo, disorientation, and mental confusion. In classical medicine, vertigo had the ambiguous status of being both a disease per se and a symptom of other diseases such as hypochondriacal melancholy. Further, two etiologies were described for vertigo: an origin in the head (brain) and an origin in the hypochondria (abdominal viscera). In the course of the development of a detailed neurologic taxonomy of vertigo in the latter half of the nineteenth century, a debate ensued whether agoraphobia was a form of vertigo or a distinct psychiatric condition. Elucidation of this forgotten debate, within its historical context, provides insights into the recent rediscovery of the balance-anxiety interface.

The social phobia and anxiety inventory: concurrent validity with a clinic sample

The Social Phobia and Anxiety Inventory (SPAI) is an empirically derived self-report inventory developed as a specific measure of social phobia. The current investigation included two studies. The first examined the correlation of the SPAI with daily social behavior of a clinic sample of social phobics. The results indicated that the SPAI provides a reasonable indication of the distress experienced during daily social encounters in three dimensions: behavior, cognitions, and overall distress. The second study examined the validity of the SPAI with reference to the somatic response and avoidance behavior of social phobics. The results indicated that the somatic items of the SPAI are related to the somatic response of social phobics and that performance on the SPAI is associated with avoidance behavior in an anxiety-producing task.

Depression and anxiety in parents of children with ADHD and varying levels of oppositional defiant behaviors: modeling relationships with family functioning.

This study investigated the relation between parental anxiety and family functioning. Parental anxiety and depression, child attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) symptoms were all included as predictors of 3 measures of family functioning to examine the independent contributions of each. Using a self-report battery completed by 45 mother-father pairs, 3 family functioning factors were derived: Parental Warmth and Positive Involvement, Intrusiveness and Negative Discipline, and Social Distress. Multilevel modeling simultaneously estimated the unique contributions of parental and child symptoms on family functioning. Results indicated that parental anxiety was negatively associated with Parental Warmth and Positive Involvement, Intrusiveness and Negative Discipline, and Social Distress; parental depression was only negatively associated with Social Distress. Child ODD symptoms had independent associations with all outcomes; no relations were found with ADHD. Sex moderated the effects of parental anxiety on Parental Warmth and Positive Involvement such that only for mothers did greater anxiety lead to less Parental Warmth and Positive Involvement.