William J. Koch

How does anxiety sensitivity vary across the anxiety disorders

Abstract According to Reiss and McNallys expectancy theory, a high level of anxiety sensitivity (“fear of anxiety”) increases the risk for anxiety disorders, and plays a particularly important role in panic disorder (PD). There has yet to be a comprehensive comparison of anxiety sensitivity across the anxiety disorders. Using a measure of anxiety sensitivity known as the Anxiety Sensitivity Index (ASI), we assessed 313 patients, representing each of the six DSM-III-R anxiety disorders. ASI scores associated with each anxiety disorder were greater than those of normal controls, with the exception of simple phobia. The latter was in the normal range. The ASI scores associated with PD were significantly higher than those of the other anxiety disorders, with the exception of posttraumatic stress disorder (PTSD). There was a trend for the ASI scores associated with PD to be greater than those associated with PTSD. Analysis of the ASI item responses revealed that PD patients scored significantly higher than PTSD patients on items more central to the concept of anxiety sensitivity, as determined by principal components analysis. The pattern of results did not change when trait anxiety was used as a covariate. The implications for the expectancy theory are considered, and directions for further investigation are outlined.

Anxiety sensitivity, trait anxiety, and the anxiety disorders

Abstract The recent debates and commentaries about the construct validity of the Anxiety Sensitivity Index (ASI) suggest several issues that remain to be resolved. First, the factor structure of the ASI remains to be clarified. Second, the distinction between this instrument and measures of trait anxiety has yet to be elucidated. A third issue concerns the extent to which the ASI and the trait version of the State-Trait Anxiety Inventory (STAI-T) can discriminate between panic disorder and other anxiety disorders. These issues were investigated by administering the ASI and the STAI-T to 142 spider-phobic college students and 93 psychiatric outpatients. In both samples, the ASI was found to be unifactorial. When the pool of ASI and STAI-T items was subjected to a factor analysis with oblique rotation, both samples yielded a two-factor solution. The STAI-T items were responsible for almost all the salient loadings on the first factor, and the ASI items were responsible for almost all the salient loadings on the second factor. In both samples the correlation between the factors was .39. These results suggest that the ASI is not simply a measure of trait anxiety. Items that are particularly important in defining the ASI concern the fear of bodily sensations. Fear of the social consequences of anxiety played a minor role in this factor. Panic-disordered patients were differentiated from patients with other anxiety disorders by ASI items pertaining to fear and catastrophic misinterpretation of bodily sensations. The full-scale score and item responses of the STAI-T were unable to differentiate between the anxiety groups. The findings support the construct validity of the ASI and the recent cognitive models of panic disorder. The results also suggest that a three-item version of the ASI may be used for the diagnosis of panic disorder.

Sexual Assault of Women Prevention Efforts and Risk Factors

Most North American universities offer sexual assault prevention programs focusing on attitude change. However, the few program outcome evaluations suggest that these programs may not be effective. This review summarizes the research on sexual assault program evaluation. It is apparent that the most promising avenue for sexual assault prevention may be self-defense training, which is presently not an integral component of typical prevention programs. The substantial body of research on risk factors for sexual assault is also reviewed, and it is concluded that existing rape prevention programs could be improved by focusing on these factors.

Conceptualizations of anxiety sensitivity

Anxiety sensitivity (fear of anxiety) is thought to play an important role in the development and maintenance of anxiety disorders. One of the most widely used measures of anxiety sensitivity is the Anxiety Sensitivity Index (ASI). The originators of this scale regarded it as a measure of a undidimensional construct (Reiss et al., 1986). Recent investigations have challenged this claim, and several 4-factor solutions have been proposed. If the dimension(s) of this scale are to guide theory and research, then it is necessary to determine the most stable factor structure. ASI responses were obtained from 142 spider-phobic college students and 327 psychiatric patients presenting with anxiety or stress-related (psychophysiological) disorders

Cognitive Restructuring in the Treatment of Social Phobia: Efficacy and Mode of Action

Cognitive restructuring (CR) is commonly used to treat social phobia, although its contribution to treatment efficacy has not been established. CR requires the person to think about and discuss feared social events with his or her therapist and thus entails some degree of exposure to social stimuli. CR also is thought to enhance the efficacy of therapeutic exposure exercises (EXP). Four predictions were tested based on this model: Relative to a control intervention matched for the exposure inherent in CR, CR is more effective in (1) reducing social phobia, (2) reducing negative social cognitions, (3) increasing positive cognitions, and (4) enhancing the effects of subsequent EXP. People with generalized social phobia (N= 60) were randomly assigned to CR followed by EXP or to a control intervention followed by EXP. Support was found for predictions 1 to 3, but not 4.

Assessment and treatment of motor vehicle accident victims

Motor vehicle accidents (MVAs) often have clinically significant psychological sequelae. Victims frequently are left with multiple comorbid psychological and physical disorders, with the most prevalent psychological problems being posttraumatic stress disorder, depression, pain-related conditions, and phobic avoidance of stimuli associated with the accident. In this article, we review the psychological assessment and treatment of MVA victims. It is important to assess the nature and subjective meaning of the accident and to examine the functional relationships between physical injuries and emotional disorders. Important issues for treatment include selecting behavioral and cognitive interventions, determining the sequence of interventions, and dealing with complications such as litigation and medication use. These points are illustrated with case examples.

Cognitive Specificity in Panic and Depression: Implications for Comorbidity

Previous studies of cognitive specificity indepression and anxiety disorders have establishedreliable profiles of depressive cognitions, and to asomewhat lesser extent, panic-related cognitions. The present study examines cognitive specificity inpure diagnostic groups of patients with panic disorderor major depression and compares cognitive profiles inthese single diagnosis groups to those observed in a group of individuals with comorbid panicand depression. In addition to Becks CognitionChecklist, we introduce a cognition inventory thatincludes subscales for panic and depression along withsomatic preoccupation, social fears, and worry. Goodspecificity was found for panic and depressioncognitions in the pure diagnostic groups, and thecomorbid group was equivalent to the pure groups onthese measures. However, the comorbid group was alsosignificantly more troubled by less prototypicalcognitions concerning social-evaluative fears andsomatic preoccupation. These results suggest thatindividuals with comorbid depression and panic may holdadditional maladaptive beliefs beyond specificcognitions typically associated with each disorderalone.

Suffocation false alarms and efficacy of cognitive behavioral therapy for panic disorder

Cognitive behavioral therapy (CBT) is an effective treatment for many but not all patients with panic disorder. This raises the question of whether there are types of panic disorder for which CBT is effective, and other types for which it is ineffective. Kleins (1993) suffocation alarm theory suggests two types of panic disordered patient: those with intense dyspnea as a frequent panic symptom ( suffocation panickers ) and those with little or no dyspnea ( nonsuffocation panickers ). Kleins theory suggests CBT will be less effective for suffocation panickers compared to nonsuffocation panickers. To test this prediction, 22 unmedicated panic-disordered patients were classified as suffocation panickers ( n = 13) or nonsuffocation panickers ( n = 9) and received 10 sessions of CBT. Both groups had significant reductions in symptoms from pre- to posttreatment, and gains were maintained at 3-month followup. Groups did not differ in treatment response. At 3-month followup 75% of suffocation panickers, and 50% of nonsuffocation panickers were panic-free, and 75% of suffocation panickers and 63% of nonsuffocation panickers were classified as treatment responders. These results fail to support the prediction from Kleins theory and suggest that panic disorder with intense dyspnea can be successfully treated with CBT.

Psychological Issues in Civil Law

The interaction between psychology and civil law issues is a relatively new, but growing area of research. That only two of the chapters in this book are devoted to civil law issues speaks to the current state of psychological knowledge in this area. This being the case, we have chosen a broad focus, with three primary goals; (a) reviewing theory and research in individuals sense of justice, which may explain why individuals resort to litigation, (b) research relating to decisionmaking in civil law, and (c) providing a brief discussion on the burgeoning area of psycholegal research in contract and property law. While this review is inevitably cursory and not comprehensive, we believe it will highlight pertinent

Reliability and Validity of the Cognition Checklist With Psychiatric Outpatients

The Cognition Checklist Anxiety scale (CCL-A) and Depression scale (CCL-D) were administered to psychiatric outpatients with panic disorder (n = 51), major depression (n = 44), or panic disorder and major depression (n = 38). Both scales showed good internal consistency and moderately high levels of test-retest reliability. The scales generally had good convergent and discriminant validities, except that the CCL-D had a moderate-sized correlation with fear of negative evaluation, and the CCL-A was uncorrelated with fear of negative evaluation. The CCL-D showed good criterion-related validity, whereas the CCL-A was weaker in this regard. The CCL scales showed good factorial validity. In all, the results suggest the CCL scales generally have adequate psychometric properties for research purposes.