The structure of negative emotions in a clinical sample of children and adolescents.

The authors sought to define the latent factors associated with childhood anxiety and depression, using a structural equations/confirmatory factor-analytic approach involving multiple informants (i.e., parent and child report) of symptoms. A sample of 216 children and adolescents with diagnoses of an anxiety disorder or comorbid anxiety and mood disorders and their parents were administered measures of childhood fear, anxiety, and depression. Results of comparative modeling best supported 3-factor solutions (fear, anxiety, and depression) that were consistent with recent conceptual models of anxiety and depression (e.g., tripartite model). Results also suggested that 3 widely used measures of childhood negative emotion are conceptually heterogeneous (containing item sets that loaded on different latent factors) . Implications for the assessment of childhood negative emotions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety disorders and intimate relationships: A study of daily processes in couples.

Although adults with anxiety disorders often report interpersonal distress, the degree to which anxiety is linked to the quality of close relationships remains unclear. The authors examined the relational impact of anxiety by sampling the daily mood and relationship quality of 33 couples in which the wife was diagnosed with an anxiety disorder. Use of a daily process design improved on prior methodologies by capturing relational processes closer to their actual occurrence and in the setting of the diagnosed partner’s anxiety. Analyses revealed significant associations between wives’ daily anxiety and both partners’ perceptions of relationship quality. Associations were moderated by anxiety-specific support. Results also indicated significant concordance between wives’ daily anxiety and husbands’ distress. Concordance was stronger for husbands who reported frequent accommodation of wives’ anxiety symptoms. Findings are discussed in the context of existing evidence on the social costs of anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional self-disclosure and emotional avoidance: Relations with symptoms of depression and anxiety.

Research suggests that individuals with heightened symptoms of mood and anxiety disorders engage in diminished emotional disclosure. On the basis of emotion regulation theories, the authors hypothesized that this symptom–disclosure relationship would be mediated by the avoidance of emotional experience and expression. In Study 1, college students (N = 831) completed measures of depression and anxiety symptoms, measures of tendencies to avoid emotional expression, and measures of tendencies to self-disclose distress. Structural equation modeling revealed that anhedonic depression and anxious arousal were associated with lessened emotional self-disclosure tendencies as mediated by avoidance of emotional expression. In Study 2, participants (N = 153) completed new measures of depression and anxiety symptoms, reflected on the most significant emotional event experienced during the past week, and rated their avoidance of emotion about the event and their self-disclosure of the event. Depression (but not anxiety) symptoms were negatively related to the disclosure of a specific event, but avoidance of emotional experience did not mediate this depression–disclosure relationship. These findings extend emotion dysregulation theory and suggest that depressive symptoms in particular are associated with reduced emotional disclosure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The two general activation systems of affect: Structural findings, evolutionary considerations, and psychobiological evidence.

D. Watson and A. Tellegen (1985) proposed a "consensual" structure of affect based on J. A. Russell's (1980) circumplex. The authors' review of the literature indicates that this 2-factor model captures robust structural properties of self-rated mood. Nevertheless, the evidence also indicates that the circumplex does not fit the data closely and needs to be refined. Most notably, the model's dimensions are not entirely independent; moreover, with the exception of Pleasantness–Unpleasantness, they are not completely bipolar. More generally, the data suggest a model that falls somewhere between classic simple structure and a true circumplex. The authors then examine two of the dimensions imbedded in this structure, which they label Negative Activation (NA) and Positive Activation (PA). The authors argue that PA and NA represent the subjective components of broader biobehavioral systems of approach and withdrawal, respectively. The authors conclude by demonstrating how this framework helps to clarify various affect-related phenomena, including circadian rhythms, sleep, and the mood disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders.

There is a substantial literature relating the personality trait anxiety sensitivity (AS; tendency to fear anxiety-related sensations) and its lower order dimensions to the mood and anxiety (i.e., internalizing) disorders. However, particularly given the disorders’ high comorbidity rates, it remains unclear whether AS is broadly related to these disorders or if it shows a pattern of differential relations. Meta-analyses of the concurrent relations of AS with the internalizing disorders were conducted based on 117 studies and 792 effect sizes. Mean Anxiety Sensitivity Index scores by diagnostic group and AS–symptom correlations both indicated that AS is most strongly related to panic, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). More specific analyses were also conducted on (a) AS correlations with symptom dimensions within individual disorders and (b) correlations between lower order AS components and symptoms. The meta-analytic correlation matrix for higher order AS–disorder relations was submitted to path analysis, modeling latent Distress disorders and Fear disorders that control for much of the shared variance among the disorders. Results of the path analysis indicated that AS is broadly related to these disorders but that agoraphobia, GAD, panic, and PTSD have the strongest associations. In addition, AS was more strongly related to the latent distress disorders than the fear disorders. Because of the contemporaneous assessment of AS and internalizing disorders in these studies, the results should not be taken to mean that AS has a stronger casual association with certain disorders. Implications for concurrent AS–internalizing relations, interpretations of the AS construct, and structural models of personality and psychopathology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Satisfaction With Therapy and Therapist Scale--Revised (STTS-R) for group psychotherapy: Psychometric properties and confirmatory factor analysis.

Patients' level of satisfaction with their therapeutic experience is a concept that is important for understanding treatment efficacy; however, patient satisfaction has received little empirical attention. The Satisfaction With Therapy and Therapist Scale (STTS) developed for group psychotherapy by T. P. S. Oei and G. J. Shuttlewood (1999) was designed to assess patients' level of satisfaction with their therapeutic endeavor. This article aims to strengthen the STTS's psychometric properties by using confirmatory factor analysis (CFA) with a large sample of patients with mood and anxiety disorders. Outpatients (N = 344) took part in the study. Exploratory factor analysis indicated 2 conceptually coherent factors that accounted for 66.9% of the variance. The 2 factors, which were similar to those found in Oei and Shuttlewood (1999), namely, Satisfaction With Therapy and Satisfaction With Therapist, were replicated. CFA revealed a 2-factor solution to be the best-fitting model. Overall, this article demonstrated that the STTS-R has sound psychometric properties and would serve as a useful instrument in assessing a patient's level of satisfaction with both group therapy and therapist in research as well as in clinical settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) groups disorders into diagnostic classes on the basis of the subjective criterion of "shared phenomenological features." There are now sufficient data to eliminate this rational system and replace it with an empirically based structure that reflects the actual similarities among disorders. The existing structural evidence establishes that the mood and anxiety disorders should be collapsed together into an overarching class of emotional disorders, which can be decomposed into 3 subclasses: the bipolar disorders (bipolar I, bipolar II, cyclothymia), the distress disorders (major depression, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder), and the fear disorders (panic disorder, agoraphobia, social phobia, specific phobia). The optimal placement of other syndromes (e.g., obsessive-compulsive disorder) needs to be clarified in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.

The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV:Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceptability and suppression of negative emotion in anxiety and mood disorders.

The present study investigated perceived acceptability and suppression of negative emotion in participants with anxiety and mood disorders. Sixty participants with these disorders and 30 control participants watched an emotion-provoking film and completed self-report measures of their experience and regulation of emotions. The film elicited similar increases in negative emotion for clinical and nonclinical participants; however, clinical participants judged their resulting emotions as less acceptable and suppressed their emotions to a greater extent. The higher level of suppression in the clinical group was attributable to females in the clinical group suppressing their emotions more than females in the nonclinical group. For all participants, high levels of suppression were associated with increased negative emotion during the film and during a postfilm recovery period. Further analyses showed that appraising emotions as unacceptable mediated the relationship between negative emotion intensity and use of suppression in the clinical group. This study extends the literature on emotion regulation to a clinical sample and suggests that judging emotions as unacceptable and suppressing emotions may be important aspects of the phenomenology of emotional disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital distress and DSM-IV psychiatric disorders in a population-based national survey.

The associations between marital distress and Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) Axis I psychiatric disorders were evaluated in a United States population-based survey of married individuals in which there was no upper age exclusionary criterion (N = 2,213). Marital distress was associated with (a) broad-band classifications of anxiety, mood, and substance use disorders and (b) all narrow-band classifications of specific disorders except for panic disorder, with the strongest associations obtained between marital distress and bipolar disorder, alcohol use disorders, and generalized anxiety disorder. The association between marital distress and major depressive disorder increased in magnitude with increasing age; there was no evidence that the association between marital distress and other psychiatric disorders was moderated by gender or age. Results support continued research on the association between couple functioning and mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Locating eating pathology within an empirical diagnostic taxonomy: Evidence from a community-based sample.

Existing structural models of psychopathology need to be expanded to include additional diagnostic constructs beyond mood, anxiety, substance use, and antisocial behavior disorders. The goal of this study was to locate eating disorders within a hierarchical structural model of psychopathology that is anchored by broad Internalizing and Externalizing factors. Participants were female adolescent twins (N = 1,434) from the Minnesota Twin Family Study. The authors compared the fit of 4 models in which eating disorders (a) defined their own diagnostic class, (b) represented a subclass within Internalizing, (c) formed a subclass within Externalizing, and (d) were allowed to cross-load on both Internalizing and Externalizing. In the best fitting model, eating disorders formed a subfactor within Internalizing. These findings underscore the value of developing more comprehensive empirically based models of psychopathology to increase researchers' understanding of diverse mental disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital distress and mental health care service utilization.

Objective: This study was designed to evaluate the association between marital distress and mental health service utilization in a population-based sample of men and women (N = 1,601). Method: The association between marital distress and mental health care service utilization was evaluated for overall mental health service utilization and for specific sectors of treatment providers, including psychiatrist, other mental health provider, other medical provider, and religious services provider. Interviews were used to assess past-year service utilization and presence of anxiety, mood, and substance use disorders. Results: Approximately 12% of married individuals sought help for problems with their emotions, nerves, or substance use during the 12 months preceding the interview. Marital distress was significantly associated with (a) overall mental health service utilization and service utilization provided by each of the sectors of providers when controlling for demographic variables and (b) overall mental health service utilization and receiving treatment from a psychiatrist when additionally controlling for past-year anxiety, mood, or substance use disorders. There was little evidence that the associations between marital distress and service utilization were moderated by gender or presence of psychiatric disorders. Conclusion: The finding that marital distress is associated with greater mental health care service utilization suggests that clinicians should assess both individual and relationship factors among individuals presenting for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structure of Anxiety and Depression in Urban Youth: An Examination of the Tripartite Model.

In this study, the authors examined the validity of the tripartite model of anxiety and depression (L. A. Clark & D. Watson, 1991) in a community epidemiological sample of 467 urban African American youth. Participants completed the Baltimore How I Feel (N. S. Ialongo, S. G. Kellam, & J. Poduska, 1999), a measure of anxiety and depressive symptoms, in Grades 6 and 9. Confirmatory factor analyses indicated that a 3-factor model representing the tripartite model fit the data well and better than competing models. Longitudinal confirmatory factor analysis revealed configural invariance of the tripartite factor structure. However, a predicted divergence among dimensions over time was not evidenced. High correlations among the tripartite dimensions suggest that anxiety and mood symptoms may not differentiate in urban youth. Results are discussed in terms of the ethnicity and urban context of this community sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis.

There has been significant interest in the role of anxiety sensitivity (AS) in the anxiety disorders. In this meta-analysis, we empirically evaluate differences in AS between anxiety disorders, mood disorders, and nonclinical controls. A total of 38 published studies (N = 20,146) were included in the analysis. The results yielded a large effect size indicating greater AS among anxiety disorder patients versus nonclinical controls (d = 1.61). However, this effect was maintained only for panic disorder patients compared to mood disorder patients (d = 0.85). Panic disorder was also associated with greater AS compared to other anxiety disorders except for posttraumatic stress disorder (d = 0.04). Otherwise the anxiety disorders generally did not differ from each other in AS. Although these findings suggest that AS is central to the phenomenology of panic disorder and posttraumatic stress disorder, causal inferences regarding the role of AS in these anxiety disorders cannot be made. Moderator analyses showed that a greater proportion of female participants was associated with larger differences in AS between anxiety and nonclinical control groups. However, more female participants were associated with a smaller AS difference between anxiety and mood disorder groups. This finding suggests that AS is less robust in distinguishing anxiety from mood disorders among women. Age also moderated some observed effects such that AS was more strongly associated with anxiety disorders in adults compared to children. Type of AS measure used also moderated some effects. Implications of these findings for the conceptualization of AS in anxiety-related disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders.

The reliability of current and lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) anxiety and mood disorders was examined in 362 outpatients who underwent 2 independent administrations of the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV–L). Good to excellent reliability was obtained for the majority of DSM-IV categories. For many disorders, a common source of unreliability was disagreements on whether constituent symptoms were sufficient in number, severity, or duration to meet DSM-IV diagnostic criteria. These analyses also highlighted potential boundary problems for some disorders (e.g., generalized anxiety disorder and major depressive disorder). Analyses of ADIS-IV–L clinical ratings (0–8 scales) indicated favorable interrater agreement for the dimensional features of DSM-IV anxiety and mood disorders. The findings are discussed in regard to their implications for the classification of emotional disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3.

Accumulating evidence suggests that anxiety sensitivity (fear of arousal-related sensations) plays an important role in many clinical conditions, particularly anxiety disorders. Research has increasingly focused on how the basic dimensions of anxiety sensitivity are related to various forms of psychopathology. Such work has been hampered because the original measure--the Anxiety Sensitivity Index (ASI)--was not designed to be multidimensional. Subsequently developed multidimensional measures have unstable factor structures or measure only a subset of the most widely replicated factors. Therefore, the authors developed, via factor analysis of responses from U.S. and Canadian nonclinical participants (n = 2,361), an 18-item measure, the ASI-3, which assesses the 3 factors best replicated in previous research: Physical, Cognitive, and Social Concerns. Factorial validity of the ASI-3 was supported by confirmatory factor analyses of 6 replication samples, including nonclinical samples from the United States and Canada, France, Mexico, the Netherlands, and Spain (n = 4,494) and a clinical sample from the United States and Canada (n = 390). The ASI-3 displayed generally good performance on other indices of reliability and validity, along with evidence of improved psychometric properties over the original ASI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The experience and meta-experience of mood.

Mood experience is comprised of at least two elements: the direct experience of the mood and a meta-level of experience that consists of thoughts and feelings about the mood. In Study 1, a two-dimensional structure for the direct experience of mood (Watson & Tellegen, 1985) was tested for its fit to the responses of 1,572 subjects who each completed one of the three different mood scales, including a brief scale developed to assist future research. The Watson and Tellegen structure was supported across all three scales. In Study 2, meta-mood experience was conceptualized as the product of a mood regulatory process that monitors, evaluates, and at times changes mood. A scale to measure meta-mood experience was administered to 160 participants along with the brief mood scale. People's levels on the meta-mood dimensions were found to differ across moods. Meta-mood experiences may also constitute an important part of the phenomenology of the personal experience of mood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Accurate identification of fear facial expressions predicts prosocial behavior.

The fear facial expression is a distress cue that is associated with the provision of help and prosocial behavior. Prior psychiatric studies have found deficits in the recognition of this expression by individuals with antisocial tendencies. However, no prior study has shown accuracy for recognition of fear to predict actual prosocial or antisocial behavior in an experimental setting. In 3 studies, the authors tested the prediction that individuals who recognize fear more accurately will behave more prosocially. In Study 1, participants who identified fear more accurately also donated more money and time to a victim in a classic altruism paradigm. In Studies 2 and 3, participants' ability to identify the fear expression predicted prosocial behavior in a novel task designed to control for confounding variables. In Study 3, accuracy for recognizing fear proved a better predictor of prosocial behavior than gender, mood, or scores on an empathy scale. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comorbid anxiety disorders and treatment of depression in people with multiple sclerosis.

Objective: Anxiety is highly comorbid with depression, but little is known about the impact of anxiety disorders on the effectiveness of empirically supported psychotherapies for depression. We examined such outcomes for people with Multiple Sclerosis (MS) and depression, with versus without comorbid anxiety disorders. Design: Participants with MS (N = 102) received 16 weeks of telephone-administered psychotherapy for depression and were followed for one year post-treatment. Results: Participants with comorbid anxiety disorders improved to a similar degree during treatment as those without anxiety disorders. Outcomes during follow-up were mixed, and thus we divided the anxiety diagnoses into distress and fear disorders. The distress disorder (GAD) was associated with elevated anxiety symptoms during and after treatment. In contrast, fear disorders (i.e., panic disorder, agoraphobia, social phobia, specific phobia) were linked to depression, specifically during follow-up, across 3 different measures. Conclusions: People with GAD receiving treatment for depression may benefit from additional services targeting anxiety more specifically, while those with comorbid fear disorders may benefit from services targeting maintenance of gains after treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)