William C. Sanderson

Guilt, discord, and alienation: the role of religious strain in depression and suicidality.

Although religion is usually portrayed as a source of comfort, individuals may also experience strain in their religious lives. Associations between religious variables and psychological distress were examined within two groups: a nonclinical sample of 200 college students and a clinical sample of 54 persons seeking outpatient psychotherapy. Participants reported more comfort than strain associated with religion. Religious strain was associated with greater depression and suicidality, regardless of religiosity levels or the degree of comfort found in religion. Depression was associated with feelings of alienation from God and, among students, with interpersonal conflicts on religious domains. Suicidality was associated with religious fear and guilt, particularly with belief in having committed an unforgivable sin. Religious strain, along with religiosity, was associated with greater interest in addressing religious issues in psychotherapy. These results highlight the role of religious strain as a potentially important indicator of psychological distress.

A description of patients diagnosed with DSM-III—R generalized anxiety disorder.

In the revision to DSM-III, generalized anxiety disorder (GAD) is no longer considered only a residual category but can be diagnosed even when other axis I disorders are present. In this report, we present basic descriptive data on 22 patients meeting DSM-III-R criteria for GAD. Specific spheres of worry most commonly reported by patients with GAD are presented as well as data suggesting that these spheres of worry can be identified and judged as excessive or unrealistic in a reliable fashion. Nearly all GAD patients receive an additional diagnosis (comorbidity). Patterns of comorbidity indicate a high frequency of social phobia as an additional diagnosis in this sample. The present study suggests that, consistent with the new definition of GAD, a group of patients exist who worry excessively about two or more life circumstances and have the accompanying physiological symptoms with sufficient severity to satisfy the diagnostic criteria. Preliminary evidence suggests that this pattern of chronic intense worry about life circumstances discriminates GAD from other anxiety disorders.

The Relationship Between Parenting Style, Cognitive Style, and Anxiety and Depression: Does Increased Early Adversity Influence Symptom Severity Through the Mediating Role of Cognitive Style?

Despite the central role accorded to cognitive style in mediating the relationship between negative parenting and the development of anxiety and depression, few studies have empirically examined this relationship. Using a clinical sample, this study examined the relationship between early experiences with low care, increased control, abuse and neglect, and symptoms of anxiety and depression, via the mediating effects of cognitive style. It was found that individuals who rate their parents as being more abusive and neglectful reported a greater degree of depression and that this relationship was mediated by dysfunctional cognitive style. These findings contribute to the growing literature by providing support for the role of cognitions in mediating the link between negative parenting and psychopathology.

Suicide assessment: Clinical interview vs. self‐report

This study examined whether patients disclosed the same information about suicidal behaviors on a self-report instrument that they conveyed to a clinician in a face-to-face interview. The results indicated a generally high level of agreement between these two forms of suicide assessment. The one exception was the question that concerns recent suicidal ideation, where patients tended to disclose more on the self-report form.

Five percent carbon dioxide challenge: Valid analogue and marker of panic disorder?

The administration of 5% carbon dioxide (CO2) to patients with panic disorder (PD) induces a behavioral response similar to a naturally occurring panic attack. This article reviews the literature on the nature and incidence of this response. We conclude that the 5% CO2 challenge test is a valid and useful laboratory analogue of naturally occurring panic attacks, and shows promise as a marker to identify a subset of PD patients. Though further research on reliability, validity, and dose-response effects must be conducted, the CO2 challenge test provides important information regarding the phenomenology of panic states.

Social phobia features across the DSM-III-R anxiety disorders

One hundred sixty subjects meeting DSM-III-R criteria for the five major anxiety disorders were compared on the extent to which they reported features characteristic of social phobia. The results indicated that many patients in the anxiety disorder categories experience some degree of social anxiety. The differences between subjects with a primary diagnosis of social phobia and subjects with other anxiety disorders appear to be chiefly quantitative on this feature. Compared to the other anxiety disorders, social phobics report fear and avoidance in response to a greater number of social situations and report greater interference in their lives due to social phobic concerns. Among the anxiety disorders, generalized anxiety disorder appears to be associated with the greatest degree of social anxiety, and simple phobia with the least.

Differences in reported symptom profile between panic disorder and other DSM-III-R anxiety disorders

Previous research has indicated that reports of panic attacks are associated with a different set of symptoms to reports of generalized anxiety. The present two studies attempted to extend these findings to specific (situational) fears. In Study 1, 55 subjects with panic disorder were compared on their symptom profile during their panic attacks to 65 subjects with other anxiety disorders [simple phobia, social phobia and obsessive-compulsive disorder (OCD)] during response to their feared cue. The results indicated that, compared to subjects with other anxiety disorders, subjects with panic disorder were more likely to report parasthesias, dizziness, faintness, unreality, dyspnea, fear of dying and fear of going crazy/losing control. In Study 2, 90 subjects meeting diagnostic criteria for both panic disorder and another anxiety disorder (simple phobia, social phobia or OCD) were compared on the symptoms experienced during their unexpected panic attacks and their situationally-triggered fears respectively. Combining the symptoms found in Study 1 to differ between the groups into a linear combination, there was a significant interaction found between the type of fear reaction (panic attack vs cued fear response) and symptom group. Taken together, these findings suggest that reports of unexpected panic attacks associated with panic disorder are characterized by a different symptom profile to reports of specific fear reactions that are part of a phobic disorder or OCD.

The relationships among panic, fear, and avoidance

Abstract Interview data from 57 patients assigned a diagnosis of panic disorder with agoraphobia were analyzed in terms of panic, and fear and avoidance of specific situations. Patients were categorized into three avoidance groups (mild, moderate, and severe) in accordance with revisions proposed for DSM-III. Severe avoiders were reportedly experiencing panic as frequently as mild and moderate avoiders, suggesting that panic frequency is not the major determinant of avoidance behavior. Panic frequency was more closely related to fear ratings than to avoidance ratings. Fear of panic was characteristic of all avoidance groups. Previous history of panic was unrelated to current patterns of fear and avoidance. A long history of repeated panic was frequently unaccompanied by a pattern of extensive avoidance. The relevance of the data to an interoceptive conditioning model of panic in agoraphobia and to the role of unexpected panic attacks is discussed.

Why Empirically Supported Psychological Treatments Are Important

The emergence of managed care and similar reimbursement systems that require greater accountability and the development of clinical practice guidelines have increased the importance of evidence-based clinical practice. As a result of these two trends, it appears as though the future of psychotherapy will require clinicians to deliver a psychological intervention that is supported by research. Such treatments exist for a variety of the most common presenting problems (e.g., anxiety disorders, depression) but to date have frequently gone unrecognized and underutilized. The current article will discuss the importance of identifying, promoting, and disseminating empirically supported therapies with an emphasis on the efforts of the American Psychological Association Society of Clinical Psychologys Committee on Science and Practice.

Functional interrelationship of serotonin and norepinephrine: Cortisol response to MCPP and DMI in patients with panic disorder, patients with depression, and normal control subjects☆

The relationship between norepinephrine (NE) and serotonin (5-hydroxytryptamine; 5HT) functioning was explored in a neuroendocrine challenge paradigm. Ten normal control subjects, 17 patients with major depression, and 22 patients with panic disorder volunteered to participate in this study. Each subject received a challenge with meta-chlorophenylpiperazine (MCPP; 0.25 mg/kg, p.o.), a 5HT agonist, and desmethylimipramine (DMI; 75 mg, i.m.), an indirect NE agonist, in randomized order. The peak-minus-baseline cortisol response to MCPP was used as an indicator of 5HT function, and cortisol response at 75 minutes-minus-baseline to DMI was used as an indicator of NE function. The cortisol responses to DMI and MCPP were found to be highly negatively correlated in the total sample, in particular in the patients with major depression and panic disorder. This finding suggests that the functions (or dysfunctions) of the NE and 5HT systems may not be separate as is usually believed, and that the NE and 5HT disturbances observed in major depression and panic disorder may not be independent. Rather, there may be a joint disturbance of NE-5HT in these disorders.