Sheila R. Woody

Implicit associations for fear-relevant stimuli among individuals with snake and spider fears.

This study investigated an implicit measure of cognitive processing, the Implicit Association Test (IAT; A. G. Greenwald, D. E. McGhee, & J. L. K. Schwartz, 1998), as a measure of fear-related automatic associations. Sixty-seven students with snake or spider fears completed 4 IAT tasks in which they classified pictures of snakes and spiders along with descriptive words indicating valence, fear, danger, or disgust. Results indicated that all 4 tasks discriminated between fear groups in terms of their implicit associations, and fear-specific effects were significant even after controlling for the impact of valence evaluation. Findings are discussed in terms of applications of the IAT methodology to examine cognitive processing and schemata in anxiety and potential uses for assessing anxiety disorders.

Perceived responsibility: Structure and significance

Given the postulated significance of inflated responsibility in obsessive compulsive disorder (OCD), there is a need for clarification of the concept itself and a means for measuring such responsibility. Two psychometric studies were conducted in order to develop a reliable self-report scale. In the first study 291 students completed the specially constructed Responsibility Appraisal Questionnaire (RAQ). Four factors emerged: responsibility for harm, responsibility in social contexts, a positive outlook towards responsibility, and thought-action fusion (TAF). In the second study, 234 students completed a revised RAQ. Four comparable factors emerged, and the TAF subscale correlated significantly with measures of obsessionality, guilt, and depression. The correlations between TAF and obsessionality and guilt remained significant even after BDI scores were controlled. It is concluded that the broad concept of inflated responsibility needs to be qualified; the connection between inflated responsibility and OCD appears to be situation-specific and idiosyncratic. There is more inflated responsibility than there is OCD. The measured concept of inflated responsibility is multifactorial (harm, social, positive, and TAF), not unitary. The TAF factor appears to be particularly significant in OCD.

Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale.

The reliability and validity of the Yale-Brown Obsessive-Compulsive Scale were examined according to a multi-trait multi-method approach in a sample of 54 outpatients with obsessive-compulsive disorder (OCD). Internal consistency was acceptable but was improved by deletion of items concerning resistance to obsessions and compulsions. Inter-rater reliability was excellent, but test-retest reliability over an average interval of 48.5 days was lower than desirable. The YBOCS demonstrated good convergent validity with most other measures of OCD, but divergent validity vis à vis depression was poor. Analyses of new items assessing avoidance and the duration of obsession-free and compulsion-free intervals indicated that only the avoidance rating added meaningfully to the full scale score. In future research the authors recommend deletion of the resistance items and inclusion of the avoidance item to yield a revised 9-item YBOCS total score.

Self-focused attention in the treatment of social phobia

For those with social phobia self-focused attention has been linked with impairment in social performance increased social anxiety, and a higher frequency of self-critical thoughts during social situations. The purpose of this investigation was to assess correlates of changes in situational self-focus over the course of cognitive-behavioral treatment (CBT). Focus of attention was assessed after in-session role-plays and after in vivo homework assignments during group CBT for social phobia. Analyses revealed a significant decrease in self-focused attention over time; focus on events and stimuli outside of the self remained unchanged. Treatment gains on anxiety during dyadic interactions, on negative self-judgments, and on personalized social fears were related to reduction in self-focused attention. Those with public speaking phobias showed a strong relationship between decreased self-focus and speech anxiety. These findings suggest that changes in self-focused attention during the course of CBT are related to important therapeutic gains Specific interventions aimed at decreasing self-focus may be a useful treatment strategy.

Therapeutic alliance, group cohesion, and homework compliance during cognitive-behavioral group treatment of social phobia

Previous research on the role of therapeutic alliance in cognitive behavioral interventions has shown mixed results. Building on the suggestion that the trajectory of the therapeutic relationship may be more predictive of outcome than simple level of alliance, we examined therapeutic alliance, group cohesion, and homework compliance over the course of treatment for 53 socially phobic clients involved in cognitive-behavioral group therapy. Working alliance increased in a linear fashion over the course of treatment, particularly for clients with social fears limited to public speaking. Homework compliance declined linearly, while group cohesion remained static. Curvilinear models did not explain additional variance beyond the linear terms. Notably, treatment outcome was not significantly related to the development of alliance or decline in homework compliance.

Memory for facial expressions in social phobia

Memory biases toward threat have been documented in several anxiety disorders, but contradictory findings have recently been reported in social phobics recognition of facial expressions. The present study examined recognition memory in clients with social phobia, in an effort to clarify previous inconsistent results. Just before giving a speech to a live audience, social phobia clients and normal controls viewed photographs of people with reassuring and threatening facial expressions. The stimuli were later presented again alongside photographs of the same person with a different facial expression, and participants chose which face they had seen before. Individuals with social phobia were less accurate at recognizing previously seen photographs than controls, apparently due to state anxiety. In contrast, social phobics did not show a memory bias toward threatening facial expressions. Theoretical and treatment implications are discussed.

Comorbid panic disorder and major depression: implications for cognitive-behavioral therapy.

Panic disorder and major depression frequently coexist, yet the implications of comorbidity for psychological treatments have rarely been studied. The objective of this study was to evaluate whether pretreatment comorbidity of major depression affects the outcome of cognitive-behavioral treatment (CBT) of panic disorder. Thirty-seven clients who met diagnostic criteria for both panic and major depression participated in 10 sessions of individual CBT for panic. Treatment outcome was contrasted with the outcome of 53 clients having only panic disorder who received the same treatment. The co-occurrence of depression did not adversely affect CBT for panic. These results have implications for clinical practice and theoretical implications for the nature of the relationship between panic and depression.

The usefulness of the Obsessive Compulsive Scale of the Symptom Checklist-90-Revised

The reliability and validity of the SCL-90-R Obsessive Compulsive Scale were examined using a multi-trait multi-method approach in a sample of 54 outpatients with obsessive-compulsive disorder (OCD). The OC scale proved to be internally consistent. Evidence for convergent validity was mixed, and the results suggest poor divergent and criterion-related validities. The scale demonstrated sensitivity to changes with behavioral treatment. Overall, the SCL-90-R proved to be a poor measure of OCD symptoms.

Sensitivity of Outcome Measures for Treatments of Generalized Social Phobia

To accurately evaluate treatments of generalized social phobia, it is not sufficient that measures be reliable and valid, they also must be sensitive to treatment-related changes. The present study evaluated the sensitivity of the following five measures: (a) The Social Phobia scale from the Social Phobia and Anxiety Inventory (SPAI-SP), (b) the SPAI difference score (SPAI-D), (c) the short form of the Fear of Negative Evaluation Scale (FNE-S), (d) the Social Phobia scale from the Fear Questionnaire (FQ-SP), and (e) peak anxiety during an impromptu speech task. Unmedicated people with generalized social phobia (N = 60) were randomly allocated to one of the following two treatments: (a) eight sessions of associative therapy (AT; i.e., free association to socially relevant thoughts and memories), followed by eight sessions of in vivo exposure (EXP); or (b) eight sessions of cognitive restructuring (CR), followed by eight sessions of EXP. Outcome measures were completed on entry into the study, after completing AT or CR (post-I), after completing EXP (post-II), and at 3-month follow-up. For each outcome measure, effect sizes were computed for post-I, post-II, and follow-up. The SPAI-SP and SPAI-D tended to have the largest effect sizes, and the FNE-S and FQ-SP tended to yield the smallest effects. The results add to the growing body of research supporting the usefulness of the SPAI scales as a treatment-outcome measure for studies of generalized social phobia.

Treatment of major depression in the context of panic disorder

BACKGROUNDnIndividuals with major depression frequently have panic attacks, and often panic disorder, but rarely have researchers studied the impact of comorbidity of panic on the outcome of psychological treatment of depression.nnnMETHODSnIn this study, patients with comorbid panic and depression were first treated with cognitive-behavioral therapy (CBT) for panic. Depression symptoms in this treated group were compared to a group of patients with major depression who were on a minimal therapist contact waitlist. In the second phase of the study, patients in both groups (comorbid and depression-only) were treated with CBT for depression.nnnRESULTSnCBT for panic had little effect on co-existing depression, suggesting a specificity of action for CBT directed at different disorders. In addition, the presence of current or recently remitted panic attacks or agoraphobic avoidance did not interfere with the outcome of CBT for depression.nnnCONCLUSIONnThese findings stand in contrast to previous studies showing greater linkage between depression and panic in treatment outcome.nnnLIMITATIONSnWhile there are implications for treatment planning, these conclusions may be limited by the exclusion criteria and the highly structured treatment approach of separating treatment for panic from treatment for depression.