Overprediction of anxiety, and disconfirmatory processes, in anxiety disorders

The overprediction of anxiety phenomenon and its relationships with fear, dysfunctional and functional beliefs, and emotional experiences during confrontations with feared stimuli were investigated in two studies. Study 1 investigated exposure in vivo exercises executed by anxiety patients during treatment (n = 37). Study 2 investigated behavioural experiments executed by anxiety patients (n = 11) during cognitive treatment. In both studies patients rated various variables just before and immediately after their exercises. The results indicate that anxiety patients tend to overpredict the level of anxiety they are going to experience. There is no evidence that this phenomenon is a statistical artefact, caused for instance by a pre-test response style. There is also no evidence that the observed adjustment of incorrect anxiety predictions is a statistical artefact. A global negative emotional evaluation of the experience appears to have an adverse influence on the reduction of anxiety predictions and on the reduction of fear. Fear, and its reduction after exposure in vivo or after behavioural tests, appears to be influenced by both anxiety predictions and dysfunctional beliefs. Positive emotions and functional beliefs did not appear to play an important role. The interrelationships between these factors are comprised in a path-model which describes how emotional and cognitive information yielded by disconfirmatory experiences influences changes in anxiety predictions and changes in fear. Unexpectedly, change in dysfunctional belief did not relate directly to change in fear, but only indirectly, via change in anxiety predictions. Theoretical and therapeutical implications are discussed.     

Are different parts of the extended amygdala involved in fear versus anxiety?

Although there is a close correspondence between fear and anxiety, and the study of fear in animals has been extremely valuable for understanding brain systems that are important for anxiety, it is equally clear that a richer animal model of human anxiety disorders would include measures of both stimulus-specific fear and something less stimulus specific, more akin to anxiety. Studies in patients with posttraumatic stress syndrome indicate these individuals seem to show normal fear reactions but abnormal anxiety measured with the acoustic startle reflex. Studies in rats, also using the startle reflex, indicate that highly processed explicit cue information (lights, tones, touch) activates the central nucleus of the amygdala, which in turn activates hypothalamic and brain stem target areas involved in specific signs of fear. Somewhat less explicit information, such as that produced by exposure to a threating environment for several minutes or by intraventricular administration of the peptide corticotropin-releasing hormone may activate a brain area closely related to the amygdala, called the bed nucleus of the stria terminalis, which in turn activates hypothalamic and brain stem target areas involved in specific signs of fear or anxiety. Because the nature of this information may be less specific than that produced by an explicit cue, and of much longer duration, activation of the bed nucleus of the stria terminalis may be more akin to anxiety than to fear.     

Success and failure in the behavioral treatment of obsessive-compulsives.

Attempted to construct a model for predicting success and failure in the behavioral treatment (exposure and response prevention) of obsessive-compulsives (N?=?50, mean age 34 yrs). Three sets of variables—demographic, pretreatment level of neurotic symptomatology, and S's responses during exposure sessions—were examined. Seven variables were found to be related to outcome at posttreatment and/or at follow-up: Pretreatment level of depression and of anxiety, reactivity, and habituation of reported anxiety to feared stimuli within- and between-sessions were all found to affect outcome at posttreatment. Posttreatment outcome as well as age at symptom onset were significantly related to maintenance of gains. A model of the interrelationships of these variables was constructed and tested by a path analysis. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

From normal fear to pathological anxiety.

In this article the authors address how pathological anxiety may develop from adaptive fear states. Fear responses (e.g., freezing, startle, heart rate and blood pressure changes, and increased vigilance) are functionally adaptive behavioral and perceptual responses elicited during danger to facilitate appropriate defensive responses that can reduce danger or injury (e.g., escape and avoidance). Fear is a central motive state of action tendencies subserved by fear circuits, with the amygdala playing a central role. Pathological anxiety is conceptualized as an exaggerated fear state in which hyperexcitability of fear circuits that include the amygdala and extended amygdala (i.e., bed nucleus of the strict terminalis) is expressed as hypervigilance and increased behavioral responsivity to fearful stimuli. Reduced thresholds for activation and hyperexcitability in fear circuits develop through sensitization- or kindling-like processes that involve neuropeptides, hormones, and other proteins. Hyperexcitability in fear circuits is expressed as pathological anxiety that is manifested in the various anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An investigation of gender differences in social phobia

The present study was an exploratory investigation of gender differences in a large sample of persons with social phobia. Potential differences in demographic characteristics, comorbidity, severity of fear, and situations feared were examined. No differences were found on history of social phobia, social phobia subtype, or comorbidity of additional anxiety disorders, mood disorders, or avoidant personality disorder. However, women exhibited more severe social fears as indexed by several assessment instruments. Some differences between men and women also emerged in their report of severity of fear in specific situations. Women reported significantly greater fear than men while talking to authority, acting/performing/giving a talk in front of an audience, working while being observed, entering a room when others are already seated, being the center of attention, speaking up at a meeting, expressing disagreement or disapproval to people they do not know very well, giving a report to a group, and giving a party. Men reported significantly more fear than women regarding urinating in public bathrooms and returning goods to a store. Additionally, there were some differences in the proportion of men and women reporting fear in different situations. Specifically, more women than men reported fear of going to a party, and more men than women reported fear of urinating in a public restroom. Gender differences among patients with social phobia are discussed in the context of traditional sex-role expectations.     

Cognitive self-control strategies with the anxious student.

Discusses the differences in anxiety problems of university students from classic phobias in the variety of antecedent stimuli and the nature and prevalence of cognitive activity. Due to such differences and to the value students place on self-control, cognitive strategies are useful in anxiety management training. The importance of determining the variety of situations that produce anxiety and the extent to which ruminations are involved is stressed. The goals of cognitive anxiety management training are for the client to learn to identify early signals of anxiety, to analyze his/her own cognitive activity, and to refocus attention away from anxiety-producing thoughts. Roleplaying, covert rehearsal, and homework assignments involving the techniques are cited as potential aids in reshaping cognitive responses to uncomfortable situations. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lower limb revascularization in diabetics

Pure cognition and hence pure cognitive dysfunction might be expected to have no direct relation to any specific emotion. Changes in cognitive processing will change the assessment of stimuli and thus could change emotional responses nonspecifically. However, neurology suggests a more direct relation between at least some aspects of cognition and emotion. The limbic system in general and the hippocampus in particular have been suggested at different times to be crucial for both memory and emotion. Even recently, O'Keefe and Nadel (The hippocampus as a cognitive map, Oxford University Press, 1978) proposed that the hippocampus is a spatial, or cognitive, map, while Gray (The neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. Oxford University Press, 1982) proposed that it is central to anxiety. This apparent incongruity can be resolved by combining recent developments in the psychology of anxiety (which emphasise changed processing biases), recent extensions of Gray's theory (which bring it closer to cognitive views), and recent theories of the role of the hippocampus in memory (which see it as controlling rather than storing information). This paper proposes that at least some instances of clinical anxiety could result from hyperactivity of the septo-hippocampal system, which would produce cognitive dysfunction in the form of increased negative association of stimuli with a consequential increase in anxiety when the stimuli are subsequently presented.     

Virtual reality for the psychophysiological assessment of phobic fear: Responses during virtual tunnel driving.

An overall assessment of phobic fear requires not only a verbal self-report of fear but also an assessment of behavioral and physiological responses. Virtual reality can be used to simulate realistic (phobic) situations and therefore should be useful for inducing emotions in a controlled, standardized way. Verbal and physiological fear reactions were examined in 15 highly tunnel-fearful and 15 matched control participants in 3 virtual driving scenarios: an open environment, a partially open tunnel (gallery), and a closed tunnel. Highly tunnel-fearful participants were characterized by elevated fear responses specifically during tunnel drives as reflected in verbal fear ratings, heart rate reactions, and startle responses. Heart rate and fear ratings differentiated highly tunnel-fearful from control participants with an accuracy of 88% and 93%, respectively. Results indicate that virtual environments are valuable tools for the assessment of fear reactions and should be used in future experimental research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictability, controllability, and fear of symptoms of anxiety in epinephrine-induced panic

BACKGROUND: Psychological manipulations (supplied information, safety cues) may influence panic rates during pharmacologic challenge tests in subjects with panic disorder (PD). Psychological panic models assume that fear of stress-related bodily sensations is central to the etiology of PD. METHODS: Prior to infusion of epinephrine, 50 subjects with PD were randomly assigned to one out of four experimental conditions: with or without extensive information and with or without external control, according to a 2 x 2 design. The panic rate was hypothesized to be lower in subgroups possessing extensive information and/or control. Fear of bodily sensations was used as a predictor. RESULTS: Thirty-four out of 50 patients (68%) panicked during the infusion. Subjects who received extensive information were marginally less likely to panic, but manipulation of control did not influence panic rates. Panickers did not differ from nonpanickers in measures of fear of fear. Anxiety sensitivity best predicted baseline anxiety and cognitive symptom scores, but was not associated with other outcome measures in panickers. Only baseline partial pressure of CO2 discriminated between panickers and nonpanickers. CONCLUSIONS: Manipulating external safety cues appears to be of limited value in modulating responses to epinephrine challenge. Together with our finding that fear of anxiety symptoms does not predict panic rates, these data argue against "fear of fear" as a key mechanism in epinephrine-induced panic.     

The origins of specific phobias: Influential theories and current perspectives.

Fears are quick and adaptive responses that permit powerful reply to imminent threats. Less adaptive, phobias are extreme manifestations of fear to objects or situations in the absence of a proportional danger. Although the utility of fear is accepted, the nature of phobias is controversial. Initial theories favored a fear conditioning-based explanation, with vicarious and information learning pathways subsequently included as additional routes to the development of specific phobias. More recently, an important group of investigations strengthened the case for a nonassociative account of fear acquisition proposing that evolutionarily relevant fears can occur without any need of critical learning experiences. In parallel, there is some evidence for a dedicated fear module in the detection of threats, involving the amygdala, which is relatively independent from conscious cognitive control. Nonetheless, cognitive models stress learning and developmental factors and their role in the etiology and maintenance of phobic behavior. This article critically reviews each of these views and theories stressing their recent developments, weaknesses, and controversies with an aim to provide the groundwork for the construction of a more integrated position. Finally, the authors suggest encouraging trends in recent research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social anxiety disorder subtypes and their mental health correlates in a nationally representative Canadian sample.

The present study aimed to assess the merit of subtyping social anxiety disorder by validating the nongeneralised subtype, differentiating the generalised and nongeneralised subtypes, and determining the role of feared social situations. Data came from the Canadian Community Health Survey Cycle 1.2 (N = 36,984) of adults aged 15 years and older. Social anxiety disorder was assessed with the World Mental Health Composite International Diagnostic Interview. In accordance with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV) criteria, generalised social anxiety disorder was defined as fearing at least 7 (i.e., most) of 13 feared social situations, whereas nongeneralised social anxiety disorder as fearing 6 or fewer. Results indicated that the nongeneralised subtype was associated with increased odds of comorbid mood, anxiety, and suicidality compared with non-socially anxious adults. Conversely, the generalised subtype was not associated with increased odds of comorbid mental disorders and suicide attempts compared with the nongeneralised subtype after controlling for sociodemographic factors and other comorbid Axis I disorders. Finally, as the number of feared social situations increased, so did the odds of suffering from comorbid mood and anxiety disorders and suicidality. The present study has important implications for the DSM–5. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Know thy memory: The use of questionnaires to assess and study memory.

Reviews the properties of 14 questionnaires (including the Cognitive Failures Questionnaire, the Inventory of Learning Processes, and the Memory Change Questionnaire) developed independently to assess people's beliefs about their memory performance in natural circumstances. Research has found that responses to these questionnaires are reliable but that they correspond only moderately with a person's memory performance. Apparently, people's beliefs about their memory performance are stable but not accurate. Research also has found that responses to memory questionnaires vary with several variables: the kind of memory failure, susceptibility to cognitive failures under stress, confidence in memory performance, and age of Ss. Thus, although memory questionnaires are only moderately successful indicators of memory performance, they may nevertheless elucidate the properties of beliefs that underlie performance. (93 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fear-reduction research and clinical phobias.

Reviews research concerning the behavioral treatment of clinical phobias, and compares findings with related analog studies of Ss with mild fears. Despite the frequently expressed need for caution in generalizing from one population or type of fear to another, earlier reviews based largely on analog studies have tended to ignore this problem. Conclusions regarding the effects of nonspecific treatment variables, anxiety levels during treatment, imaginal or real exposure to phobic situations, and motivational variables in changing phobic behavior are qualified by reference to research with clinical populations. These findings suggest that analog studies may give misleading impressions of the relative importance of different components operating in clinical treatments. (66 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-efficacy and expectancy: Old wine with new labels.

Discusses inconsistent definitions of self-efficacy and outcome expectancies, which have been a source of conceptual confusion. A. Bandura (1977; see also PA, Vols 58:5733 and 71:6766) used the term outcome expectancy in 2 different ways, each implying a different relation to self-efficacy. In tests of ability, self-efficacy had been operationalized in ways that are virtually identical to J. B. Rotter's (1954, 1972, 1982) expectancy construct, and both theories generate identical predictions. In these situations, low self-efficacy does not elicit fear. Bandura's examples of low snake-approach self-efficacy are inconsistent with his method of measuring the construct. Questionnaires purporting to measure people's judgments about their ability to approach a feared stimulus actually measure their willingness to approach the stimulus. Willingness to approach a feared stimulus is affected by anticipated harm, expected anxiety, and the magnitude of expected reinforcements. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consistency, specificity, and correlates of negative emotions.

Four studies with college student participants examined the consistency, specificity, and correlates of sadness, fear, and anger. Study 1 measured emotions with daily diaries, and Study 2 examined the relationship between trait emotions and state emotions. Studies 1 and 2 indicated that specific negative emotions are temporally stable, are positively correlated, and provide information above and beyond that provided by other negative emotions. Study 3 found that negative emotions are differentially associated with different facets of cognitive style, as measured by questionnaires that examined dysfunctional attitudes and attributions concerning negative events. Study 4 indicated that negative emotions are differentially associated with different facets of response style, as measured by the degree to which individuals described their thoughts, feelings, and actions in response to hypothetical events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fear and anxiety as separable emotions: An investigation of the revised reinforcement sensitivity theory of personality.

The Gray and McNaughton (2000) theory draws on a wide range of animal data to hypothesize that the emotions of fear and anxiety are separable. The authors tested their hypothesis in two studies. The first study examined associations between scores on questionnaire measures of fear, anxiety, and neuroticism; correlational analysis revealed that fear and anxiety are not interchangeable constructs. The second study examined associations between scores on questionnaire measures of fear/anxiety and performance in a military training setting; regression analysis revealed that fear captured significant variance in performance that was not shared with anxiety. These results imply that hypotheses derived from nonhuman animal data may hold important implications for understanding human emotion and motivation, especially in relation to fear and anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of lorazepam on film-induced differentiated emotions in healthy volunteers

We studied the effects of lorazepam, a benzodiazepine, on differentiated emotions in healthy volunteers. In order to induce differentiated emotions, film excerpts were selected on the basis of the type of emotion they induced (fear, anger and for affective tone neutral film). For 6 days (D1 to D6), ten healthy volunteers received lorazepam (1 mg bid) or placebo in a randomized cross-over double-blind trial. During each treatment period, emotional induction occurred on D4, D5 and D6. One film excerpt (fear, anger or neutral) was presented each morning after relaxation. Evaluation was performed before and after each emotional induction and included questionnaires (Differential Emotions Scale and physical activation visual analog scales), and neurophysiological parameters (systolic and diastolic blood pressure, heart rate and norepinephrine levels). Globally, the film excerpts induced the predicted emotions. An analysis of variance was undertaken and revealed a significant effect of lorazepam versus placebo. On the Differential Emotions Scale and during fear induction, lorazepam induced a significantly higher increase in fear, anxiety and disgust emotions than placebo, whereas no effect was observed after anger induction. Lorazepam also induced a significantly higher increase in diastolic and systolic blood pressure with no change in heart rate, and physical activation items ("tears" and "faster breathing") without no significant change in norepinephrine. In conclusion, our results are consistent with an overall increase in emotional reactivity with lorazepam (1 mg bid) as compared to placebo. The pertinence of film-induced differentiated emotions has to be confirmed for clinical pharmacological use.     

H(+)-coupled alpha-methylaminoisobutyric acid transport in human intestinal Caco-2 cells

Numerous theoretical as well as pharmacological arguments lead to the assumption that anxiety and memory are two closely linked concepts. Nevertheless, the study of this relationship is full of complexities because neither memory nor anxiety are unitary phenomena. Indeed, the term memory covers a large number of concepts, and anxiety has been divided in two main classes, "state" and "trait" anxiety. Recently the neophobic responses exhibited by Balb/c mice confronted to the free exploratory paradigm have been proposed as a "trait anxiety" model while response exhibited in the light/dark choice procedure as a "state anxiety" one. The aim of this study was to further clarify the link between these two anxiety types and memory of emotional events assessed in the passive avoidance test. The relationship between the variables measured in these three tests were assessed by a principal component analysis that confirmed that the behavior recorded in the two anxiety tests does not reflect the same psychological state, and showed that emotional memory is linked to "state" but not "trait" anxiety.     

Cross-species collapse activity of polarized radial glia on retinal ganglion cell axons

Anxiety sensitivity has been implicated as a risk factor in the development and maintenance of anxiety and fear-related disorders. Indeed, persons who score high on the anxiety sensitivity index (ASI) are generally more responsive to biological challenge procedures such as CO2-inhalation that directly evoke the feared bodily events. One would expect, therefore, that persons high on anxiety sensitivity should be more conditionable and hence more likely to acquire fears, than persons low on anxiety sensitivity when CO2-enriched air is used as an unconditioned stimulus (UCS). Undergraduates (N = 96), scoring high, medium and low on the ASI received 8 repeated 20-s inhalations of either 20 or 13% CO2-enriched air (UCSs) paired with one of three CSs differing in fear-relevance (snake, heart and flowers). Several autonomic and self-report measures were assessed. Contrary to expectation, electrodermal and cardiac conditioned responses failed to discriminate between ASI groups. Yet, SUDS and severity and frequency of DSM-IV panic symptoms varied reliably as a function of anxiety sensitivity. Overall, the findings suggest that anxiety sensitivity is related to subjective fear-related complaints, but not autonomic responding and conditionability. We discuss clinical and theoretical implications for understanding the place fo anxiety sensitivity in fear onset.     

Neural structures associated with recognition of facial expressions of basic emotions

People with Huntington's disease and people suffering from obsessive compulsive disorder show severe deficits in recognizing facial expressions of disgust, whereas people with lesions restricted to the amygdala are especially impaired in recognizing facial expressions of fear. This double dissociation implies that recognition of certain basic emotions may be associated with distinct and non-overlapping neural substrates. Some authors, however, emphasize the general importance of the ventral parts of the frontal cortex in emotion recognition, regardless of the emotion being recognized. In this study, we used functional magnetic resonance imaging to locate neural structures that are critical for recognition of facial expressions of basic emotions by investigating cerebral activation of six healthy adults performing a gender discrimination task on images of faces expressing disgust, fear and anger. Activation in response to these faces was compared with that for faces showing neutral expressions. Disgusted facial expressions activated the right putamen and the left insula cortex, whereas enhanced activity in the posterior part of the right gyrus cinguli and the medial temporal gyrus of the left hemisphere was observed during processing of angry faces. Fearful expressions activated the right fusiform gyrus and the left dorsolateral frontal cortex. For all three emotions investigated, we also found activation of the inferior part of the left frontal cortex (Brodmann area 47). These results support the hypotheses derived from neuropsychological findings, that (i) recognition of disgust, fear and anger is based on separate neural systems, and that (ii) the output of these systems converges on frontal regions for further information processing.