According to the National Institute of Mental Health, “Anxiety is a normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam, keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder.”
The five major types of anxiety disorders include:
- Generalized Anxiety Disorder
- Obsessive-Compulsive Disorder (OCD)
- Panic Disorder
- Post-Traumatic Stress Disorder (PTSD)
- Social Phobia (or Social Anxiety Disorder)
Retrieved from http://www.nimh.nih.gov/health/topics/generalized-anxiety-disorder-gad/index.shtml on 2/28/07.
The National Institute of Mental Health (NIMH) and the Anxiety Disorders Association of America (ADAA) provide an array of information demonstrating the prevalence of anxiety disorders and their affect on individuals, families, and society. Anxiety disorders are the most common mental illness in the United States, with 40 million or18.1 percent of the adult U.S. population (age 18 and older) affected. According to “The Economic Burden of Anxiety Disorders,” a study commissioned by the ADAA and based on data gathered by the Association and published in the Journal of Clinical Psychiatry, anxiety disorders cost the United States more than $42 billion a year—almost one-third of the $148 billion total mental health bill for the United States.
Retrieved from http://www.adaa.org/AboutADAA/PressRoom/Stats&Facts.asp on 2/28/07
Many distinct forms of anxiety disorders disproportionately affect women, according to ADAA. Women are twice as likely as men to experience general anxiety disorder and panic disorder, and are diagnosed with OCD, social phobias, and PTSD equally or more than men. Most individuals have more than one anxiety disorder since these disorders are often comorbid with depression, bipolar disorder, and other mental and physical illnesses. More than 75 percent of individuals with an anxiety disorder have their first experience by age 22. Anxiety disorders are the most common mental illnesses diagnosed in children.
Significant gains have been made in the diagnosis and treatment of anxiety disorders, including several standardized assessment tools. Treatment generally includes a mix of cognitive-behavioral therapy (CBT) and medication, specifically anti-depressants or anxiolytics. A large body of research documents the efficacy of CBT as a first-line treatment. With appropriate treatment, the symptoms of anxiety disorders, such as avoidance, compulsions, and physiological accompaniments, can be significantly diminished.
A review of recent research related to anxiety disorders reveals three interest areas: (1) co-morbidity with other psychiatric or physical illnesses; (2) attempts to refine diagnoses through measurement validation; and (3) exploration of family relationships, such as the role of parental influence in the development of the disorder, living with a parent or sibling who manifests the disorder, and managing behavior which may or may not be caused by the disorder.
The fact that NIMH is currently conducting 14 clinical trials related to anxiety disorders indicates both the growing interest in defining and finding treatment, and the relative lack of previous research specific to this disorder, which was often subsumed in other diagnostic categories or seen as secondary to other mental illnesses. It also reflects a growing emergence of a disorder that, by its very nature, remains hidden since people living with extreme anxiety or phobias often disengage from social contacts in response to symptoms. Historically, the mental health field has considered anxiety disorders to be less serious than other mental illnesses and has characterized people living with the disorders as “the worried well.” Research and prevalence statistics now show that these disorders take a serious toll on quality of life and can result in suicide.
The following resources and references provide a current and growing body of knowledge upon which to base tested assessment techniques and interventions.
National Institute of Mental Health
NIMH provides publications and a listing of 14 current clinical trials related to the treatment of anxiety disorders. Information about the recruitment of participants in these clinical trials is also provided.
Anxiety Disorders Association of America (ADAA)
The Anxiety Disorders Association of America (ADAA) is the only national, non-profit organization solely dedicated to informing the public, health care professionals, and legislators that anxiety disorders are real, serious, and treatable. The ADAA promotes the early diagnosis, treatment, and cure of anxiety disorders, and is committed to improving the lives of people who suffer from them. The ADAA provides brochures and other published materials on anxiety disorders and their treatment. Most of the materials can be downloaded at no cost from the Web site. The ADAA’s official journal, Depression and Anxiety, publishes current research on mood disorders. The ADAA Online Bookstore offers a large selection of high quality publications and materials for and about anxiety disorders. ADAA holds an annual conference for clinicians and researchers and provides training and continuing education through workshops. Professionals can join ADAA and be listed on the online directory of treatment professionals, and individuals can support the mission of the ADAA through donations.
Freedom From Fear (FFF)
Freedom From Fear conducts the National Anxiety Disorders Screening Day, founded in 1994, which is a free program to educate the public about anxiety and depressive illnesses and to offer individuals the opportunity to receive a free screening for these illnesses. The last program took place on May 3, 2006. Since its inception, more than 1 million individuals have been screened. The National Association of Social Workers (NASW) co-sponsored this campaign in 2004 in which social worker participants received a packet to assist in conducting the project that included screening instruments, several videos (including “Physical Pain: The Other Side of Anxiety” and “Depression and Afraid of People: Understanding Social Anxiety Disorder,” a CD Rom with mental health fact sheets, and other educational materials.
- The National Institute of Mental Health Web site includes:
A detailed booklet that describes the symptoms, causes, and treatments of the major anxiety disorders, with information on getting help and coping.
The NIMH Web site (above) includes links to a number of publications, including fact sheets related to each type of anxiety disorder.
- The Anxiety Disorders Association of America Web site includes the following:
|•||Improving the Diagnosis & Treatment of Generalized Anxiety Disorder (download now)|
|•||Anxiety Disorders in Women – Setting A Research Agenda|
- Behavior Research and Therapy
At least two issues of this journal focus on anxiety disorders:
- 44(2). January 2006.
- 43(7). July 2005.
The following publication abstracts provide a perspective on current research concerning anxiety disorders. They are neither a complete compendium of current research, nor are the studies necessarily conducted by social work researchers. Culled from Social Work Abstracts ™, they reflect the growing knowledge base of assessment and treatment of anxiety disorders. The abstracts are grouped under the headings of Assessment and Measurement, Family Issues, and Treatment and Interventions.
Assessment and Measurement
An exploratory study of suicidal ideation and comorbid disorders in adolescents and young adults with Asperger’s Syndrome.
DA: Fordham Univ, PhD, Sept. 2006.
Evidence suggests that suicidal ideation increases during adolescence.Currently, there are no data on the prevalence of suicidal ideation among adolescents and young adults diagnosed with AS. This exploratory study examined: 1) the level of suicidal ideation, prevalence of comorbid psychiatric disorders, degree of peer victimization, and level of stigma; and 2) the association of suicidal ideation with: age, age at diagnosis, severity of AS symptomatology, Major Depressive Disorder, level of depressive symptomatology, Generalized Anxiety Disorder, level of anxiety symptomatology, degree of peer victimization, or level of stigma. A cross-sectional study using a self-administered mail questionnaire and a web-based questionnaire were used. Two samples were selected for this study. The first sample used snowball sampling, starting with parents of adolescents or young adults diagnosed with AS who participated in a 2002 study. The second sample consisted of a volunteer sample of parents who visited one out of three web sites for individuals with AS and their families. The sample included 10 participants. Fifty percent of the sample had clinically significant levels of suicidal ideation, 20% met criteria for a diagnosis of Major Depressive Disorder and 30% met criteria for Generalized Anxiety Disorder. Bivariate analyses revealed that severity of AS symptomatology was negatively correlated with level of suicidal ideation (r = -.88, p = .01). Participants who were employed were almost seven years older at the time of diagnosis as compared with participants who were not employed. Participants who were not employed had levels of AS symptomatology that was 23 points higher on the KAID (p = .02). Other hypotheses were not supported by the small sample and resulted in very low power for most tests. Implications for social work include: 1) studies of suicidal ideation and comorbid disorders in adolescents and young adults diagnosed with AS should include a large probability sample that will allow a more detailed investigation of the potential risk factors for suicidal ideation; 2) social work practitioners and mental health professionals should be aware of the potential risk factors for suicidal ideation among adolescents and young adults diagnosed with AS that were identified in this study. (Dissertation abstract.)
Psychometric properties of the social phobia inventory: Further evaluation.
AU: Antony-M-M; Coons-M-J; McCabe-R-E; Ashbaugh-A; Swinson-R-P
SO: Behaviour-Research-and-Therapy. 44(8): 1177-1185, Aug. 2006.
This study investigated the psychometric properties of the Social Phobia Inventory [SPIN; Connor, K. M., Davidson, J. R. T., Churchill, L. E.,
Sherwood, A., Foa, E., Wesler, R.H., 2000. Psychometric properties of the Social Phobia Inventory (SPIN). British Journal of Psychiatry, 176, 379-386], a measure of severity in social phobia (social anxiety disorder). Participants included 132 participants with social phobia, 57 participants with panic disorder and agoraphobia (PDA), and 62 participants with obsessive-compulsive disorder (OCD). Confirming findings from an initial validation study, the SPIN was found to have excellent internal consistency and good test-retest reliability. It also distinguished well between those with social phobia and those with either PDA or OCD. Good convergent and discriminant validity were established by examining correlations with other conceptually related and unrelated scales. Finally, the SPIN was sensitive to changes in social phobia severity following cognitive behavioral group treatment. In conclusion, the SPIN is both reliable and valid for the measurement of social phobia severity and outcome following psychological treatment. (Journal abstract.)
Social anxiety and problematic cannabis use: Evaluating the moderating role of stress reactivity and perceived coping.
AU: Buckner-J-D; Schmidt-N-B; Bobadilla-L; Taylor-J
SO: Behaviour-Research-and-Therapy. 44(7): 1007-1015, July 2006.
Despite epidemiological reports indicating an association between social anxiety disorder (SAD) and cannabis use disorders (CUD), there is a paucity of research exploring the nature of this relationship. The present investigation examined potential moderators of this relationship that are consistent with a tension-reduction model of addiction. Specifically, physiological reactivity to stress and perceived coping with stress were evaluated as moderators of the relation between symptoms of SAD and CUD. Physiological (SCR) and subjective (perceived coping) responses to unpredictable white noise bursts were collected from non-clinical participants (n = 123). Lifetime symptoms of CUD and anxiety disorders were assessed using a structured diagnostic interview. CUD symptomatology was associated with symptoms of SAD but not with symptoms of any other anxiety disorder. Only perceived coping to unpredictable stimuli moderated the relationship between SAD and CUD symptoms. Findings are discussed in the context of tension-reduction models of co-occurring social anxiety and problematic cannabis use. (Journal abstract.)
Social anxiety disorder in Veterans Affairs primary care clinics.
AU: Kashdan-T-B; Frueh-B-C; Knapp-R-G; Hebert-R; Magruder-K-M
SO: Behaviour-Research-and-Therapy. 44(2): 233-247, Jan. 2006.
To examine the prevalence and correlates of social anxiety disorder (SAD) in veterans, 733 veterans from four VA primary care clinics were evaluated
using self-report questionnaires, telephone interview, and a 12-month retrospective review of primary care charts. We also tested the concordance between primary care providers’ detection of anxiety problems and diagnoses of SAD from psychiatric interviews. For the multisite sample, 3.6% met criteria for SAD. A greater rate of SAD was found in veterans with than without posttraumatic stress disorder (PTSD) (22.0% vs. 1.1%), and primary care providers detected anxiety problems in only 58% of veterans with SAD. The elevated rate of comorbid psychiatric diagnoses and suicidal risk associated with SAD was not attributable to PTSD symptom severity. Moreover, even after controlling for the presence of major depressive disorder, SAD retained unique, adverse effects on PTSD diagnoses and severity, the presence of other psychiatric conditions, and suicidal risk. These results attest to strong relations between SAD and PTSD, the inadequate recognition of SAD in primary care settings, and the significant distress and impairment associated with SAD in veterans. (Journal abstract.)
Development of the Anxiety Change Expectancy Scale (ACES) and validation in college, community, and clinical samples.
AU: Dozois-D-J-A; Westra-H-A
SO: Behaviour-Research-and-Therapy. 43(12): 1655-1672, Dec. 2005.
This study investigated the psychometric properties of a newly developed 20-item instrument that assesses one’s anticipation of being able to change anxiety: the Anxiety Change Expectancy Scale (ACES). Study 1 evaluated the ACES in undergraduate university students, self-identified as experiencing difficulties with anxiety. Study 2 examined the ACES in a community sample of persons with anxiety difficulties. Study 3 tested the utility of the ACES in predicting treatment change in a group of individuals with generalized anxiety disorder participating in group cognitive behavioral therapy for anxiety. Across these samples, the ACES demonstrated excellent internal reliability (coefficient alphas = .89-.92) as well as good convergent, divergent, and factorial validity. The ACES was also significantly predictive of treatment-related changes in somatic anxiety symptoms and worry. The results of these studies provide strong support for the ACES as a reliable and valid measure of expectancies for changinganxiety. (Journal abstract.)
The structural relationships among generalized anxiety, obsessions -compulsions, and depression at the syndrome and sub-syndrome level.
AD: dr email@example.com
SO: Behaviour-Research-and-Therapy. 43(12): 1587-1609, Dec. 2005.
The study explored anxiety’s relationship to depression by assessing a group of 592 undergraduate psychology students at Washington State University. Multiple measures of generalized anxiety (GA), obsessions- -compulsions (O–C), and depression were used to conduct several confirmatory factor analyses (CFAs). A three-factor model of GA, O–C, and depression was found superior in fit to a one-factor “negative-affect” model, a two-factor model of anxiety and depression, and a second–order three–factor model. Further CFAs divided GA, O–C, and depression into six independent symptom category factors using instrument subscales (e.g., worry, somatic anxiety, obsessions, compulsions, cognitive depression, and somatic depression). The fit for this model was superior to three alternative measurement models. The correlations among the six symptom category constructs revealed differential patterns among the cognitive and somatic symptoms. (Journal abstract.)
Development of anxiety disorders in a traumatized pediatric population: A preliminary longitudinal evaluation.
AU: Cortes-A-M; Saltzman-K-M; Weems-C-F; Regnault-H-P; Reiss-A-L; Carrion-V-G
SO: Child-Abuse-and-Neglect. 29(8): 905-914, Aug. 2005.
This study was conducted to determine if posttraumatic stress disorder (PTSD) symptomatology predicted later development of non-PTSD anxiety disorders in children and adolescents victimized by interpersonal trauma. Thirty-four children with a history of interpersonal trauma and no initial diagnosis of anxiety disorder participated in the study. Children were assessed at time one (T1) and then 12-18 months later at time two (T2). At T1, the Clinician Administered PTSD Scale for Children and Adolescents (CAP-CA) and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) were used to evaluate children’s PTSD symptoms and comorbid non-PTSD anxiety disorder diagnosis. At T2, the CAPS-CA and the K-SADS-PL were repeated. The diagnosis of PTSD and PTSD symptoms in children exposed to interpersonal trauma at T1, particularly the symptoms associated with avoidance and constricted emotional expression (criteria C) as well as physiological hyperarousal (criteria D), predicted the development of other anxiety disorders at T2. (Journal abstract.)
Perception of control over anxiety mediates the relation between catastrophic thinking and social anxiety in social phobia.
SO: Behaviour-Research-and-Therapy. 43(7): 885-895, July 2005.
Cognitive models of social phobia (social anxiety disorder) assume that individuals with social phobia experience anxiety in social situations in part because they overestimate the social cost associated with a potentially negative outcome of a social interaction. Some emotion theorists, on the other hand, point to the perception of control over anxiety-related symptoms as a determinant of social anxiety. In order to examine the relationship between perceived emotional control (PEC), estimated social cost (ESC), and subjective anxiety, the authors compared three alternative structural equation models: Model 1 assumed that PEC and ESC independently predict social anxiety; Model 2 assumed that ESC partially mediates the relationship between PEC and anxiety, and Model 3 assumed that PEC partially mediates the relationship between ESC and anxiety. The authors recruited 144 participants with social phobia and administered self-report measures of estimated social cost, perceived anxiety control, and social anxiety. The results supported Model 3 and suggested that “costly” social situations are anxiety provoking in part because social phobic individuals perceive their anxiety symptoms as being out of control. (Journal abstract.)
Negative problem orientation (Part II): Construct validity and specificity to worry.
AU: Robichaud-M; Dugas-M-J
SO: Behaviour-Research-and-Therapy. 43(3): 403-412, March 2005.
Negative problem orientation, a dysfunctional set of attitudes related to problem-solving ability, has been implicated as a process variable in several psychological disorders, notably depression and generalized anxiety disorder (GAD). The goal of this study was two-fold: (1) to further examine the construct validity of a new measure of negative problem orientation, the negative problem orientation questionnaire (NPOQ), through its relationship to conceptually similar variables, and (2) to investigate the specificity of negative problem orientation to worry, the cardinal feature of GAD, compared to depression. The sample consisted of 148 university students who completed six questionnaires, the NPOQ and measures of worry, depression, pessimism, self-mastery, and neuroticism. Multiple hierarchical regressions revealed that when entered in the last step following demographic information and personality variables (pessimism, self-mastery, and neuroticism), the NPOQ accounted for 5.6% of the variance in worry scores compared to 1.6% of the variance in depression scores. It was concluded that the NPOQ shows evidence of construct validity, and that the process variable of negative problem orientation appears to have greater specificity to worry than depression. Implications for the understanding of worry and GAD are discussed. (Journal abstract.)
Interpretive cues and ambiguity in generalized anxiety disorder.
AU: Hazlett-Stevens-H; Borkovec-T-D
SO: Behaviour-Research-and-Therapy. 42(8): 881-892, Aug. 2004.
This study investigated whether generalized anxiety disorder (GAD) individuals rely on antecedent information to interpret ambiguity and whether reliance on such preceding cues persists in the absence of potential threat. Twenty-six GAD and 23 nonanxious control college students performed a lexical decision task, using homographs (i.e., words with multiple meanings) as ambiguous primes. In half the trials, a homograph prime that possessed both threat-related, as well as neutral meanings was followed by a target word related to one of these two meanings. In addition, each ambiguous prime was immediately preceded by a series of four antecedent words that were either: (a) associated with the threatening meaning of the prime; (b) associated with the neutral meaning of the prime; or (c) unrelated to either meaning of the homograph, as well as the target. Homographs for which both meanings were neutral in valence comprised the other half of the trials. Effect size statistics suggested that GAD participants used the antecedent words to interpret the homograph primes with threat-related meanings, unlike their nonanxious counterparts (p < 0.06). When both meanings of the homograph prime were neutral in valence, the GAD group appeared deficient in the use of preceding information to interpret the ambiguous prime. (Journal abstract.)
The psychometric properties of the Interpersonal Sensitivity Measure in
social anxiety disorder.
AU: Harb-G-C; Heimberg-R-G; Fresco-D-M; Schneier-F-R; Liebowitz-M-R
SO: Behaviour-Research-and-Therapy. 40(8): 961-979, Aug. 2002.
The Interpersonal Sensitivity Measure (IPSM) was developed to assess hypersensitivity to interpersonal rejection, a suggested trait of depression-prone personality (Aust NZJ Psychiatry 23 (1989) 341). Although studies of the IPSM and interpersonal rejection sensitivity have primarily been conducted in depressed populations, it is important to investigate interpersonal rejection sensitivity as a relevant construct in the assessment of social anxiety. This study examined the psychometric properties of the IPSM in treatment-seeking individuals with social anxiety disorder. The results of this investigation support the convergent and divergent validity and internal consistency of the IPSM in socially anxious individuals. An exploratory factor analysis of the scale was also conducted after the original factor and subscale structure was shown to be a poor fit for the present data. Three factors emerged (Interpersonal Worry and Dependency, Low Self-Esteem, and Unassertive Interpersonal Behavior), and 29 items were retained. Because they demonstrated negative factor loadings on Factor 2, it is suggested that the scoring for four items of the original IPSM be reversed. In summary, the revised IPSM assesses three aspects of interpersonal rejection sensitivity and appears to be a valid and reliable instrument for its assessment in social anxiety disorder. (Journal abstract.)
Social work assessment of separation anxiety disorder: A review of evidence-based approaches.
SO: Child-and-Adolescent-Social-Work-Journal. 19(5): 375-391, Oct. 2002.
This article provides a description of Separation Anxiety Disorder (SAD) and its diagnosis, and reviews evidence-based methods of assessment including clinical interviews, self-report scales, parent-teacher reports, behavioral observations, and self-monitoring in order to understand the child and the relevant social ecology and to provide the basis for formulating and evaluating social work intervention strategies. (Journal abstract.)
Shyness and social phobia: A social work perspective on a problem in living.
SO: Health-and-Social-Work. 27(2): 137-144, May 2002.
Social phobia is classified as an anxiety disorder in psychiatric nomenclature. It represents a fear of performance of social interaction that significantly interferes with a person’s social or occupational functioning. The author takes issue with the fact that social phobia is considered by many professionals to be a mental illness that is often treated best with medication. Social phobia can be conceptualized from a social work perspective as an extreme shyness that can be overcome with cognitive learning and behavioral rehearsal. This article reviews the biopsychosocial causes of social phobia and presents a summary of cognitive and behavioral interventions with empirically demonstrated effectiveness. (This is one of eight articles in this special issue on mental health.) (Journal abstract.)
Comorbid anxiety and mood disorders among persons with social anxiety disorder.
AU: Erwin-B-A; Heimberg-R-G; Juster-H; Mindlin-M
SO: Behaviour-Research-and-Therapy. 40(1): 20-35, Jan. 2002.
Axis 1 comorbidity is associated with greater severity of social anxiety disorder. However, the differential effects of comorbid mood and anxiety disorders on symptom severity or treatment outcome have not been investigated. The authors evaluated 69 persons with uncomplicated social anxiety disorder, 39 persons with an additional anxiety disorder, and 33 persons with an additional mood disorder (with or without additional anxiety disorders). Those with comorbid mood disorders reported greater duration of social anxiety than those with uncomplicated social anxiety disorder. They were also judged, before and after 12 weeks of comorbid diagnosis. In contrast, persons with comorbid anxiety disorders were rated as more impaired than those with no comorbid diagnosis on only a single measure. Type of comorbid diagnosis did not result in differential ratesof improvement of social anxiety disorder. (Journal abstract.)
Anxiety sensitivity in adolescents: Factor structure and relationships to trait anxiety and symptoms of anxiety disorders and depression.
AU: Muris-P; Schmidt-H; Merckelbach-H; Schouten-E
SO: Behaviour-Research-and-Therapy. 39(1): 89-100, Jan. 2001.
The current study examined the anxiety sensitivity construct in a large sample of normal Dutch adolescents age 13-16 years (n = 819). Children completed the Childhood Anxiety Sensitivity Index (CASI) (Silverman, W.K., Fleisig, W., Rabian, B. & Peterson, R.A. ) and measures of trait anxiety, anxiety disorder symptoms and depression. Results showed that (1) anxiety sensitivity as indexed by the CASI seems to be a hierarchically organized construct with one higher-order factor (i.e., anxiety sensitivity) and three or four lower-order factors, (2) anxiety sensitivity and trait anxiety were strongly correlated, (3) anxiety sensitivity was substantially connected to symptoms of anxiety disorders (in particular panic disorder and agoraphobia) and depression, and (4) anxiety sensitivity and trait anxiety both accounted for unique proportions of the variance in anxiety disorder symptoms. Altogether these findings are in agreement with those of previous research in adult and child populations, and further support the notion that anxiety sensitivity should be viewed as an unique factor of anxiety vulnerability. (Journal abstract.)
Geriatric Depression Scale vs. Hamilton Rating Scale for Depression in a
sample of anxiety patients.
AU: Clayton-A-H; Holroyd-S; Sheldon-Keller-A
SO: Clinical-Gerontologist. 17(3): 3-13, 1997.
This study administered the Hamilton Rating Scale for Depression (HAM-D) and the Geriatric Depression Scale (GDS) to 22 elderly, cognitively intact subjects who met DSM-III-R criteria for Generalized Anxiety Disorder. The sample comprised 14 males and eight females, with a mean age of 66.05 years. The two scales had a low intercorrelation (Pearson’s r = .33). The GDS in the sample appeared much more sensitive in eliciting depressive symptoms than the HAM-D. Frequently reported symptoms of depression in this elderly sample were well represented on the GDS. For example, most of the patients reported diminished social activities with accompanying malaise and boredom. Cognitive and affective symptoms were also widely reported. In contrast, these symptoms were not assessed as thoroughly on the HAM-D, with few items addressing these symptoms. (Journal abstract.)
Attentional bias in obsessional compulsive disorder.
AU: Tata-P-R; Leibowitz-J-A; Prunty-M-J; Cameron-M; Pickering-A-D
SO: Behaviour-Research-and-Therapy. 34(1): 53-60, Jan. 1996.
To date, studies of information processing in anxiety disorders have suggested that the latter are charactered by vigilance for threatening stimuli, possibly specific to personally relevant threat content. The present study represents an attempt to establish whether patients suffering from obsessive compulsive disorder (OCD), generally classified as an anxiety disorder, show a similar cognitive bias. Thus a replication of MacLeod, Mathews and Tata’s study (Journal of Abnormal Psychology, 95, 15$20, 1986) is reported, employing modified materials of direct concern to the OCD subjects (i.e., contamination-related words). The results did indeed reveal content specific vigilance, whereby the OCD group was more vigilant for contamination content than mood-matched High Trait Anxious (HTA) controls, but the reverse was true for Social Anxiety words. Additionally, while a general threat interference effect was identified for both OCD and HTA subjects this was not content specific. A second experiment employing Low Trait Anxious subjects revealed no vigilance for threat nor any threat interference in this sample. The clinical implications and possible mechanism underlying these results are discussed. (Journal abstract.)
An information processing model of women with chronic anxiety: An integrative treatment approach.
DA: Univ. of Texas at Arlington, PhD, Dec. 1993.
This exploratory study tested a biopsychosocial treatment package for women with chronic anxiety. The treatment protocol consisted of biofeedback assisted progressive relaxation, cognitive behavioral techniques, and psychoeducation within a feminist framework. The unifying paradigm was an information processing model from General Systems Theory. Subjects were women from an urban community who met the criteria for Generalized Anxiety Disorder. Findings from a multiple baseline single subject design suggested that women with chronic anxiety improve on depression measures and psychophysiologic measures; however, negative cognitions persist. Women may not perceive long term changes in anxiety until environmental support is available for unrealistic role demands, especially primary caretaking of children, ill relatives, and elderly dependents. As long as women remain victims through role inequity, financial strain, and stereotyping in our society, chronic anxiety may remain a threat to women’s mental and physical well being.
History of childhood sexual abuse in women with depressive and anxiety disorders: A comparative study.
AU: Murrey-G-J; Bolen-J; Miller-N; Simensted-K; Robbins-M; Truskowski-F
SO: Journal-of-Sex-Education-and-Therapy. 19(1): 13-19, Spring 1993.
This study was designed to determine the reported prevalence of childhood sexual abuse in sample populations of females with depressive and anxiety disorders. Reported prevalence of childhood sexual abuse was studied in 119 women diagnosed with a depressive disorder and 66 men diagnosed with an anxiety disorder. Results showed that 43.7 percent of the depressive-disordered women and 48.5 percent of the anxiety-disordered women reported a… (Journal abstract.)
What about me? Siblings of children with an anxiety disorder.
AU: Dia-D-A; Harrington-D
SO: Social-Work-Research. 30(3): 183-187, Sept. 2006.
This exploratory study examines psychosocial functioning of siblings of children with an anxiety disorder. Parents with a child in treatment for an anxiety disorder were asked to complete the Child Behavioral Checklist for Ages 6-18 (CBCL/6-18) on that child’s sibling and a brief demographic form. Data were collected on 65 siblings; parents reported that 8 (12%) of the siblings had clinical mental health diagnoses. Of the 57 siblings who did not have a diagnosis, 31 (54%) had scores on the CBCL/6-18 in the borderline or clinical range. A parent’s having a psychiatric diagnosis and degree of family interference were predictors of internalizing behaviors and total score in the sibling. Length of treatment was also predictive of the total score. Implications for treatment planning are discussed. (Journal abstract.)
Adolescent’s perceptions of parenting behaviours and its relationship to adolescent generalized anxiety disorder symptoms.
AU: Engels-R; Meeus-W
SO: Journal-of-Adolescence. 29(3): 407-417, June 2006.
This study examined the relationship between how adolescents perceived parenting behaviors and adolescent generalized anxiety disorder (GAD) symptom scores. The 1,106 junior high and high school students (12-19 years old; 49.6% males and 50.4% females) completed questionnaires regarding their perception of parenting behaviors and self-rated symptoms of GAD. The findings of this study demonstrate that adolescent perceptions of parental alienation and rejection are strongly associated with adolescent GAD symptom scores. Additionally, mid-adolescence females perceive more parental alienation in relation to their GAD symptom scores than both early and mid-adolescent males. And early adolescent males perceive more parental rejection in relation to their GAD symptom scores than mid-adolescent males. (Journal abstract.)
Offspring of anxious parents: Reactivity, habituation, and anxiety -proneness.
AU: Turner-S-M; Beidel-D-C; Roberson-Nay-R
SO: Behaviour-Research-and-Therapy. 43(10): 1263-1279, Oct. 2005.
Reactivity and habituation patterns were examined in the offspring of anxious and non-anxious parents. Although no differences emerged for magnitude of response to either fear-relevant visual or auditory stimuli, offspring of anxious parents displayed significantly more electrodermal activity during resting baseline and during the inter-trial intervals of these stimulus presentations. Differences also were observed for the number of children per group achieving habituation to the fear-relevant visual and auditory stimuli, where offspring of anxious parents were less likely to habituate to either stimuli. The same pattern of group differences emerged after excluding children diagnosed with an anxiety disorder, indicating that even offspring of anxious parents who did not have an anxiety disorder differ from offspring of normal controls with respect to their pattern of psychophysiological reactivity. It is hypothesized that these features might serve as an indication of anxiety proneness and risk for the development of anxiety disorders. (Journal abstract.)
Family and marital profiles of couples in which one partner has depression or anxiety.
AU: Hickey-D; Carr-A; Dooley-B; Guerin-S; Butler-E; Fitzpatrick-L
SO: Journal-of-Marital-and-Family-Therapy. 31(2): 171-182, April 2005.
Twenty-nine couples in which one partner was depressed, 21 couples in which one partner had an anxiety disorder, and 26 nondistressed control couples were compared on measures of (1) quality of life, stress, and social support; (2) family functioning; (3) marital functioning; and (4) relationship attributions. The depressed group had significant difficulties in all four domains. In contrast, the control group showed minimal difficulties. The profile of the anxious group occupied an intermediate position between those of the other two groups, with some difficulties in all four domains, although these were less severe and pervasive than those of the depressed group. (Journal abstract.)
Parenting behaviors in parent with anxiety disorders.
AU: Turner-S-M; Beidel-D-C; Roberson-Nay-R; Tervo-K
SO: Behaviour-Research-and-Therapy. 41(5): 541-554, May 2003.
Anxiety disorders are familial, and although considerable evidence supports the role of genetic/biological parameters in their development, these alone do not entirely explain their etiology. In this study, the role of parenting behavior as a possible factor in the transmission of anxiety from parent to child was examined. Using interview, self-report, and direct behavioral observation, behaviors of parents with an anxiety disorder were compared to those of parents without an anxiety disorder on a number of dimensions, but particularly with respect to whether anxious parents actively inhibited their children from engaging in normal age appropriate activities. These behaviors were assessed during routine activities and in a structured non-conflictual play task. Although anxious parents did not overtly restrict their child’s behavior in either type of activity, they reported higher levels of distress when their children were engaged in these activities. Similarly, the “emotional climate” in families with an anxious parent differed significantly from families without an anxious parent. The results are discussed in terms of how parenting behaviors might influence the development of maladaptive anxiety via social learning and information transfer, and their heuristic implications. (Journal abstract.)
An empirical investigation of the Bowenian concept of triangulation and its relationship to separation anxiety disorder.
DA: Adelphi Univ., DSW, Dec. 2001.
AB: Based on Murray Bowen’s concept of triangulation, this study examined the emotional relationship among the father, mother, and child, and whether or not it contributes to the occurrence of separation anxiety disorder (SAD) in the child. The sample included 19 SAD children and 65 non-clinical children between the ages of seven and 12. Respondents completed the Nuclear Family Triangulation Scale for Children and the Anxiety Disorders Interview Scale–children’s version. Data collection occurred over one year. Findings of the study indicate that children who met symptom
criteria for SAD based on the ADIS-C perceived themselves as more triangulated than those children who did not meet the criteria. Additionally, a positive correlation was found between the degree of triangulation and the number of SAD symptoms. These results suggest that the emotional dynamics that transpire among the father, mother, and child may contribute, in some measures, to SAD symptoms in the child.
Treatment and Interventions
Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children.
AU: Lyneham-H-J; Rapee-R-M
SO: Behaviour-Research-and-Therapy. 44(9): 1287-1300, Sept. 2006.
Supplementing bibliotherapy with therapist-client communication has been shown to be an effective way of providing services to under-resourced and isolated communities. The current study examined the efficacy of supplementing bibliotherapy for child anxiety disorders with therapist -initiated telephone or email sessions, or with client-initiated contact in a randomized trial using a waitlist control. Participants were 100 anxiety-disordered children and their parents from rural and remote communities. All treatment conditions resulted in improvement on self-report measures and clinician rated severity. Telephone sessions produced superior outcomes with 79% of children being anxiety disorder free post-treatment compared with 33% of email and 31% of client-initiated participants. The results suggest that therapist supplemented bibliotherapy could provide an efficacious treatment option for families isolated from traditional treatment services. (Journal abstract.)
One-year follow-up of pharmacotherapy-resistant patients with panic disorder treated with cognitive-behavior therapy: Outcome and predictors of remission.
AU: Heldt-E; Manfro-G-G; Kipper-L; Blaya-C; Isolan-L; Otto-M-W
SO: Behaviour-Research-and-Therapy. 44(5): 657-665, May 2006.
Non-response to pharmacotherapy for panic disorder (PD) is a well-documented problem. However, little information exists to guide next-step strategies for these non-responders. In addition to pharmacologic augmentation strategies, several studies support the efficacy of cognitive-behavior therapy (CBT) for these patients, although data on long-term outcomes has been lacking. In this study, the authors provide one-year outcomes on a sample of 63 patients who completed group CBT for PD after failing to respond adequately to previous pharmacotherapy. Sustained significant benefit was found for all dimensional outcome scores, and nearly two-thirds of the sample met remission criteria. This occurred with reductions in medication use over the follow-up period. Negative predictors of remission status included comorbid dysthymia, social phobia, and generalized anxiety disorder. These results provide additional evidence for the efficacy of CBT for medication non-responders with PD. (Journal abstract.)
Impact of cognitive-behavioral therapy for panic disorder on comorbidity: A
AU: Tsao-J-C-I; Mystkowski-J-L; Zucker-B-G; Craske-M-G
SO: Behaviour-Research-and-Therapy. 43(7): 959-970, July 2005.
This study examined the effects of cognitive-behavioral therapy (CBT) for principal panic disorder with or without agoraphobia, on comorbidity in 30 individuals (16 female). To test the hypothesis that improvements in co-existing conditions were not due to spontaneous fluctuations across time, patients receiving immediate CBT were compared to those assigned to wait list (n = 11). Results indicated clinician-rated severity of comorbid specific phobia declined significantly following immediate CBT compared to no change after wait list. The number of patients without comorbidity of any severity increased after immediate CBT, with no such increase following wait list. However, the groups did not differ in the frequency of additional diagnoses or overall severity of comorbidity. In the total sample, results indicated reductions in comorbidity by 9-month follow-up, with marked declines in the severity of comorbid by 9-month follow-up, with marked declines in the severity of comorbid generalized anxiety disorder (GAD), social and specific phobia. Findings suggested that targeted CBT for panic disorder has beneficial effects on comorbidity over the longer term and that some of its immediate effects exceed those due to the passage of time alone. (Journal abstract.)
Attention deficit disorder, anxiety disorder, and learning disabilities: Preliminary results of an object-relational/psychoeducational treatment approach with an eight-year-old girl.
SO: Psychoanalytic-Social-Work. 8(3/4): 169-192, 2001.
This article details an individualized psychoeducational model designed to treat a child with interrelated psychological and developmental issues whose psychic functioning was deteriorating within the traditional educational system. The team had leeway to function outside of the educational system to create an individualized, remedial, psychoeducational program. At the time the program began, the girl’s diagnostic picture included: Anxiety Disorder, Attention Deficit/Hyperactivity Disorder, and Learning Disabilities. The treatment team consisted of an education specialist, two additional part-time teachers, a clinical social worker, an occupational therapist, a consulting senior child psychoanalyst, and the child’s mother. The results at the close of the first school year are examined. Perspectives informing the psychoanalytic aspects of this case include Winnicottian and Fairbairnian Object Relations Theory and therapeutic milieu model. (Journal abstract.)
Patterns of personality pathology in patients with generalized anxiety disorder, panic disorder with and without agoraphobia, and social phobia.
AU: Dyck-I-R; Phillips-K-A; Warshaw-M-G; Dolan-R-T; Shea-T; Stout-R-L; Massion-A-O; Zlotnick-C; Keller-M-B
SO: Journal-of-Personality-Disorders. 15(1): 60-71, Feb. 2001.
The relationship between co-occurring personality disorders and anxiety disorders (panic disorder with or without agoraphobia, social phobia, and generalized anxiety disorder) was examined, taking into account the effect of major depression. This article describes findings for 622 participants in the Harvard/Brown Anxiety Research Project, a longitudinal follow-up study of DSM-III-R–defined anxiety disorders. A total of 24% of participants had at least one personality disorder, with avoidant, obsessive compulsive, dependent, and borderline most common. Generalized anxiety disorder, social phobia, and major depression were positively associated with the occurrence of one or more personality disorders, whereas panic disorder with agoraphobia was not associated. Major depression was associated in particular with dependent, borderline, histrionic, and obsessive compulsive personality disorders and social phobia was associated with avoidant personality disorder. Whereas some of our findings confirm results from earlier studies, others are somewhat inconsistent with previous results and indicate the need for further investigation. (Journal abstract.)
Cognitive-behavioral therapy with a six-year-old boy with separation anxiety disorder: A case study.
SO: Health-and-Social-Work. 26(2): 125-128, May 2001.
This article is an exploratory study examining the use of cognitive-behavioral therapy in the treatment of separation anxiety disorder (SAD). The main clinical feature of this disorder is excessive worry about the separation from home or from the person to whom the affected person is attached. The anxiety must be beyond what is expected for the developmental level and have been present for at least four weeks. Onset of the disorder must occur before 18 years of age. A child with SAD frequently reports fears that involve being kidnapped, becoming lost, or having his or her caretaker become hurt, killed, or kidnapped. When a child with SAD expects to be separated from his or her caretaker or when separation has just occurred, the child displays significant subjective distress. The child may cry, shake, express terror, and have autonomic symptoms of anxiety such as palpitations and hyperventilation. The prevalence of SAD is estimated to be about 4% in children and young adolescents. (Journal abstract.)