Ronald A. Kleinknecht

The assessment of dental fear

Multiple channel fear assessment of 128 patients was obtained in the offices of five general practitioners to evaluate a fear assessment battery consisting of self-reports, physiological measures, and overt behavior indices. Results indicated that, in general, self-reports of dental fear were most strongly related to other subjective anxiety and pain measures. The overt behavior of high and low fear patients in the waiting room and the operatory differed on only one of the many dimensions examined. The strongest “attitude-behavior” relationship was between reported fear level and appointment-keeping. The possibility that gross in-chair behaviors may be inappropriate observation targets in the assessment of adult dental fear was discussed, and an alternative strategy was previewed.

Cultural factors in social anxiety: A comparison of social phobia symptoms and Taijin Kyofusho☆

The present study examined two forms of culturally-defined social anxiety: social anxiety or phobia, as defined by DSM-IV; (i.e., a concern of public scrutiny or embarrassment) and Taijin Kyofusho (TKS), a Japanese form of social anxiety centered around concern for offending others with inappropriate behavior or offensive appearance. These versions of social anxiety are also examined in relation to culturally-determined self definition as independent and interdependent. One hundred eighty-one U.S. students and 161 students enrolled in Japanese universities were administered scales to assess social anxiety and phobia and TKS symptoms and behaviors, as well as construal of self as independent or interdependent. Factor analyses of the three scales used to assess social anxiety yielded three factors, each clearly corresponding to the respective scales and defining TKS and DSM-defined social anxiety. A case analysis indicated that there was an approximate 50% co-occurrence between high scorers on the TKS and social phobia scales. Multiple regression analyses resulted in a different set of predictors of TKS and SPS for the U.S. and Japanese respondents. Results were interpreted as suggesting that cultural variables can mediate the expression of social anxiety but that both forms of social anxiety can be found in each sample.

Disgust sensitivity and contamination fears in spider and blood–injection–injury phobias

Disgust has been implicated in the onset and maintenance of blood-injection-injury (BII) and animal phobias. Research suggests that people with these phobias are characterized by an elevated sensitivity to disgust-evoking stimuli separate from their phobic concerns. The disgust response has been described as the rejection of potential contaminants. Disgust-motivated avoidance of phobic stimuli may therefore be related to fears of contamination or infection. The present study compared BII phobics, spider phobics and nonphobics on two measures of disgust sensitivity and two measures of contamination fears. Positive correlations were found between disgust sensitivity and contamination fear. Specific phobics scored higher than nonphobics on all scales and BII phobics scored higher than spider phobics on contamination fear measures. Furthermore, the contamination fear scales were correlated with the blood phobia measure, but not correlated with the spider phobia measure. The results suggest that while both phobias are characterized by elevated disgust sensitivity, contamination fear is more prominent in BII than spider phobia.

A review of the effects of diazepam on cognitive and psychomotor performance

Studies evaluating the effects of diazepam (Valium) on psychomotor and cognitive functions are reviewed an integrated. The importance of the full and clear documentation of such drug effects lies in the wide usage of diazepam today for a variety of medical, psychiatric, and dental purposes. The various tasks used to assess drug effects were classified into six major groups based on apparent similarity of functions tapped. These groupings are: reflex speed; critical flicker fusion threshold; attention and vigilance; decision making; learning and memory; psychomotor performance. In all functions except simple reflexive responding; some indications of impaired performances were reported, the results being most definitive for the critical flicker fusion where even small doses lowered the threshold and for a slower performance on letter cancellation tasks. There appeared to be some interaction between diazepam and alcohol although the nature of this interaction is still unclear. Because of the extensive use of both of these drugs and the possibility of a synergistic or a potentiation effect, it is important that this area receive further study. It was suggested that future studies either control for or analyze the data to assess the possible interactive effects of diazepam with subject variables such as sex, personality type, and for population characteristics. These variables have been shown to affect responses in other studies and hence could also interact with cognitive and psychomotor performance. It was noted that most of the studies reviewed used normal, healthy, male volunteer subjects and may not be comparable to the clinical populations for whom the drug is typically prescribed.

The role of pain anxiety, coping, and pain self-efficacy in rheumatoid arthritis patient functioning.

Anxiety about pain is increasingly recognized as one factor contributing to increased pain perception and pain behavior [McCracken, L. M., Faber S. D., & Janeck A. S. (1998) Pain-related anxiety predicts nonspecific physical complaints in persons with chronic pain. Behavior Research and Therapy, 36, 621-630; McCracken L., & Gross R. (1995). The pain anxiety symptoms scale (PASS) and the assessment of emotional responses to pain. Innovations in clinical practice: a source book, 14, 309-321]. To assess this emotional reaction to pain in chronic pain patients, McCracken, Zayfert and Gross [McCracken, L., Zayfert, C., & Gross, R. (1992). The Pain Anxiety Symptom Scale: development and validation of a scale to measure fear of pain. Pain, 50, 67-73] developed the Pain Anxiety Symptom Scale (PASS) composed of four subscales: Cognitive Anxiety, Fearful Appraisal, Escape Avoidance and Physiological Anxiety. The present study extended previous work by examining the relationship among pain anxiety dimensions, use of active and passive coping strategies and arthritis self-efficacy as predictors of functional status in 154 rheumatoid arthritis (RA) patients. Functional status was assessed using the Five-Factor Model of the Arthritis Impact Scale, 2nd ed., (AIMS2): Physical Functioning, Affective Experience, Symptoms, Social Interaction and Role Function. Hierarchical multiple regression analysis on each of the AIMS2 criterion variables showed that pain anxiety, pain and symptom self-efficacy, health status and coping strategies were able to explain between 9 and 38% of the variance in the five AIMS2 variables. The present results support the hypothesized role of pain anxiety along with previously established contributions of self-efficacy and coping strategies, in affecting physical, social, emotional and role functioning in chronic RA patients.

Panic and panic attacks in adolescents

Abstract Patients seeking treatment for panic disorder typically report their panic onset to have been in their late 20s. Epidemiologic and other survey samples indicate that the age of onset of panics is in the late teens. The present survey study examined this and other issues related to the conditions of onset of panic and the relationship of panics to depression, psychosocial stresses, and social support in a sample of 660 adolescents, aged 13 to 18. Four groups were formed based on presence and intensity of panic attacks: No panic (36%), Mild panic (47%), Moderate panic (10%), and Severe panic (5.4%). Females were significantly more likely to be in the more severe groups than males. The median age of onset of panic attacks was 13 years and did not differ as a function of gender or panic severity. Symptom profiles during panics were highly comparable to those reported by others; situations in which attacks occurred were also essentially the same. The more severe panic groups reported significantly more school and family stresses, greater depression, less family support, and more uncued panic attacks. Ten percent of the Severe panic group and 2.9% of the total sample were currently in treatment for their panic. These results indicate panic attacks and panic disorder begin for some during adolescence. Patterns and symptomatology are highly consistent with those reported in adult and clinical samples.

An evaluation of the McGill pain questionnaire for use in dental pain assessment

&NA; Pain following tooth extraction was assessed in 60 patients using the McGill Pain Questionnaire and the Anxiety Differential, along with other measures of patient expectations and behavior. The McGill Pain Questionnaire demonstrated efficacy in assessing postextraction pain with subscale measures relating to situational anxiety, recovery time and use of analgesics. Significant overlap among the subscales (7–58% common variance) was found suggesting further scale refinement is indicated. Pain descriptive words used and mean subscale scores were similar to those previously reported for toothache pain.

The role of disgust and fear in blood and injection—related fainting symptoms: A structural equation model

Structural equation models were used to examine the relationship of blood, injection, and injury (BII) fears, disgust sensitivity, and trait anxiety to having experienced fainting-related symptoms in 722 university students. The latent variable representing BII fears was highly positively related to faint symptoms whereas that relating to disgust experiences was inversely related to fainting. A second disgust sensitivity variable was not directly related to fainting. Trait anxiety added nothing directly to the model, although it was related to BII latent variable. Additional analyses included a gender-related cross-validation which showed that models developed on one gender group did not fit well when applied to the other gender group. Blood drawings were the most common faint eliciting situations and were found to be reportedly more likely to elicit faint symptoms than were injections.

A methodological critique of the current status of Eye Movement Desensitization (EMD)

Eye Movement Desensitization (EMD) has been recently advocated as a rapid treatment for the elimination of traumatic memories responsible for the maintenance of a number of anxiety disorders and their clinical correlates. Despite a limited conceptual framework, EMD has attracted considerable interest among clinicians and researchers. The popularity and interest generated by EMD will likely result in wide usage. We present a methodological critique of it with reference to assessment, treatment outcome, and treatment process. We also provide guidelines for judging the methodological adequacy of research on EMD and suggest intensive research to assess effectiveness, treatment components, and comparisons with other procedures.

The empirical status of the clinical application of eye movement desensitization and reprocessing

The published reports of the clinical application of eye movement desensitization and reprocessing (EMDR) are reviewed in terms of empirical validity. Case studies, single-subject experiments and group design experiments on clinical problems are evaluated for the effectiveness of the protocol, component effects, comparative effects and treatment fidelity. Classification of disorders and measurement issues are addressed. The protocol frequently reduces verbal report and independent observer ratings of distress--strikingly in some instances. Psychophysiologic measures show little effect of treatment. There is little empirical evidence to indicate the effect of treatment on motoric or behavioral indices. Eye movements do not appear to be an essential component of treatment, and there have been no substantial comparisons with other treatments. No studies have adequately controlled for nonspecific (placebo) effects of treatment. Suggestions are made for applying improved methodological controls for future applications of EMDR to clinical disorders.