Development and Initial Validation of a Brief Questionnaire on the Patients' View of the In-Session Realization of the Six Core Components of Acceptance and Commitment Therapy.

Background: Assessing in-session processes is important in psychotherapy research. The aim of the present study was to create and evaluate a short questionnaire capturing the patients' view of the in-session realization of the six core components of Acceptance and Commitment Therapy (ACT). Method: In two studies, psychotherapy patients receiving ACT (Study 1: n = 87) or Cognitive-Behavioral Therapy (CBT) (Study 2, Sample 1: n = 115; Sample 2: n = 156) completed the ACT session questionnaire (ACT-SQ). Therapists were n = 9 ACT therapists (Study 1) and n = 77 CBT trainee therapists (Study 2). Results: Factor structure: Exploratory factor analyses suggested a one-factor solution for the ACT-SQ. Reliability: Cronbach's alpha of the ACT-SQ was good (Study 1: α = .81; Study 2, Sample 1: α = .84; Sample 2: α = .88). Convergent validity: The ACT-SQ was positively correlated with validated psychotherapeutic change mechanisms (p < .05). Criterion validity: Higher ACT-SQ scores were associated with better treatment outcomes (p < .05). Conclusion: The study provides preliminary evidence for the reliability and validity of the ACT-SQ to assess the in-session realization of the six core components of ACT in the patients' view. Further validation studies and ACT-SQ versions for therapists and observers are necessary.

Long-term outcome of a mental health promotion program in Germany.

Mental health promotion programs (MHP) seek to reduce sub-syndromal symptoms of mental distress and enhance positive mental health. This study evaluates the long-term effects of a mindfulness-based MHP program ('Life Balance') provided by health coaches in a multi-site field setting on mental distress, satisfaction with life and resilience. Using a controlled design, propensity score matching was used to select a control group for participants of the MHP. The total study sample (N = 3624) comprised 83% women, with a mean age of 50 years. Data was collected via mailings 1 year after study entry. Results suggest participants experience reduced emotional distress at 12-month follow-up, with a medium between-group effect size (d = 0.40) for those participants who showed clinically relevant symptoms of mental distress at study entry. The effects of the program were more pronounced in participants with higher initial distress scores. New cases of psychopathological symptoms were prevented in 1 of 16 participants. Satisfaction with life and resilience were enhanced significantly. Our data suggest 'Life Balance' shows long-term effectiveness and indicate it is possible to design MHP programs that serve as both primary and indicated prevention, and that these programs can be applied on a population basis.

Evaluation of the contribution of values clarification to a brief mindfulness meditation intervention for anxiety.

OBJECTIVE: Evaluate the incremental effects of a computerized values clarification (VC) activity on anxiety symptomology and quality of life over and above establishment of a mindfulness meditation (MM) practice. METHOD: Anxious participants (N = 120, Female = 86; Mage  = 22.26) were randomly assigned to a 2-week, 10-min daily MM practice + control task or a 2-week, 10-min daily MM practice + VC task. Pre-assessments and post-assessments included well-established and ideographic self-report measures. RESULTS: Overall decreases in past week and past 24-h anxiety symptom frequency, as well as increased quality of life during the previous 24-h cycle only. VC did not have a demonstrable impact on outcomes. CONCLUSIONS: Though findings are preliminary, brief VC exercises may not enhance outcomes that follow from mindfulness practice. Additional research is needed to isolate specific and shared impacts of mindfulness-based and values-based treatment strategies on anxiety symptoms and quality of life.

Increasing valued behaviors precedes reduction in suffering: Findings from a randomized controlled trial using ACT.

BACKGROUND: Psychological flexibility theory (PFT) suggests three key processes of change: increases in value-directed behaviors, reduction in struggle with symptoms, and reduction in suffering. We hypothesized that Acceptance and Commitment Therapy (ACT) would change these processes and that increases in valued action and decreases in struggle would precede change in suffering. METHOD: Data were derived from a randomized clinical trial testing ACT (vs. waitlist) for treatment-resistant patients with primary panic disorder with/without agoraphobia (n = 41). Valued behavior, struggle, and suffering were assessed at each of eight sessions. RESULTS: Valued actions, struggle, and suffering all changed over the course of therapy. Overall changes in struggle and suffering were interdependent whereas changes in valued behavior were largely independent. Levels of valued behaviors influenced subsequent suffering, but the other two variables did not influence subsequent levels of valued action. DISCUSSION: This finding supports a central tenet of PFT that increased (re-)engagement in valued behaviors precedes reductions in suffering. Possible implications for a better understanding of response and non-response to psychotherapy are discussed.

Evaluating the Effectiveness of ACT for Anxiety Disorders in a Self-Help Context: Outcomes From a Randomized Wait-List Controlled Trial.

Rigorous evaluations of cognitive behavioral self-help books for anxiety in pure self-help contexts are lacking. The present study evaluated the effectiveness of an Acceptance and Commitment Therapy (ACT) self-help workbook for anxiety-related concerns, with no therapist contact, in an international sample. Participants (N=503; 94% mental health diagnosis) were randomized to an immediate workbook (n=256) or wait-list condition (n=247). Assessments at pretreatment, 12weeks, 6months, and 9months evaluated anxiety and related symptoms, quality of life, and ACT treatment processes (e.g., psychological flexibility). Participants in the wait-list arm crossed over to the workbook following the 12-week assessment. The workbook condition yielded significant improvements on all assessments from pre- to posttreatment relative to wait-list, and these gains were maintained at follow-ups. The pattern observed in the wait-list condition was virtually identical to the active treatment arm after receiving the workbook, but not before. Attrition was notable, but supplemental analyses suggested dropout did not influence treatment effects for all but one measure. Overall, findings provide preliminary support for the effectiveness of this self-help workbook and suggest ACT-based self-help bibliotherapy might be a promising low-cost intervention for people experiencing significant anxiety-related concerns.

Life Balance - a mindfulness-based mental health promotion program: conceptualization, implementation, compliance and user satisfaction in a field setting.

BACKGROUND: Mental health disorders account for a large percentage of the total burden of illness and constitute a major economic challenge in industrialized countries. Several prevention programs targeted at high-risk or sub-clinical populations have been shown to decrease risk, to increase quality of life, and to be cost-efficient. However, there is a paucity of primary preventive programs aimed at the general adult population. "Life Balance" is a program that employs strategies borrowed from well-established psychotherapeutic approaches, and has been made available to the public in one federal German state by a large health care insurance company. The data presented here are the preliminary findings of an ongoing field trial examining the outcomes of the Life Balance program with regard to emotional distress, life satisfaction, resilience, and public health costs, using a matched control group design. METHODS: Life Balance courses are held at local health-care centers, in groups of 12 to 15 which are led by laypeople who have been trained on the course materials. Participants receive instruction on mindfulness and metacognitive awareness, and are assigned exercises to practice at home. Over an 8-month period in 2013-2014, all individuals who signed up for the program were invited at the time of enrollment to take part in a study involving the provision of psychometric data and of feedback on the course. A control group of subjects was invited to complete the questionnaires on psychometric data but did not receive any intervention. RESULTS: Of 4,898 adults who attended Life Balance courses over the specified period, 1,813 (37.0 %) provided evaluable study data. The average age of study participants was 49.5 years, and 83 % were female. At baseline, participants' self-reported symptoms of depression and anxiety, life satisfaction, and resilience were significantly higher than those seen in the general German population. Overall, evaluations of the course were positive, and 83 % of participants attended at least at 6 of the 7 sessions. Some sociodemographic correlations were noted: men carried out the assigned exercises less often than did women, and younger participants practiced mindfulness less frequently than did older ones. However, satisfaction and compliance with the program were similar across all sociodemographic categories. CONCLUSIONS: While the Life Balance program is publicized as a primary prevention course that is not directed at a patient population, the data indicate that it was utilized by people with a significant mental health burden, and that the concept can be generalized to a broad population. As data from the control group are not yet available, conclusions about effectiveness cannot yet be drawn. TRIAL REGISTRATION: German Clinical Trials Registration ID: DRKS00006216.

Treating Treatment-Resistant Patients with Panic Disorder and Agoraphobia Using Psychotherapy: A Randomized Controlled Switching Trial.

Background: Nonresponsiveness to therapy is generally acknowledged, but only a few studies have tested switching to psychotherapy. This study is one of the first to examine the malleability of treatment-resistant patients using acceptance and commitment therapy (ACT). Methods: This was a randomized controlled trial that included 43 patients diagnosed with primary panic disorder and/or agoraphobia (PD/A) with prior unsuccessful state-of-the-art treatment (mean number of previous sessions = 42.2). Patients were treated with an ACT manual administered by novice therapists and followed up for 6 months. They were randomized to immediate treatment (n = 33) or a 4-week waiting list (n = 10) with delayed treatment (n = 8). Treatment consisted of eight sessions, implemented twice weekly over 4 weeks. Primary outcomes were measured with the Panic and Agoraphobia Scale (PAS), the Clinical Global Impression (CGI), and the Mobility Inventory (MI). Results: At post-treatment, patients who received ACT reported significantly more improvements on the PAS and CGI (d = 0.72 and 0.89, respectively) than those who were on the waiting list, while improvement on the MI (d = 0.50) was nearly significant. Secondary outcomes were consistent with ACT theory. Follow-up assessments indicated a stable and continued improvement after treatment. The dropout rate was low (9%). Conclusions: Despite a clinically challenging sample and brief treatment administered by novice therapists, patients who received ACT reported significantly greater changes in functioning and symptomatology than those on the waiting list, with medium-to-large effect sizes that were maintained for at least 6 months. These proof-of-principle data suggest that ACT is a viable treatment option for treatment-resistant PD/A patients. Further work on switching to psychotherapy for nonresponders is clearly needed. © 2015 S. Karger AG, Basel.

Validação da versão brasileira do questionário de ansiedade cardíaca / Brazilian portuguese validated version of the cardiac anxiety questionnaire

FUNDAMENTOS: A ansiedade cardíaca (AC) é o medo de sensações cardíacas, caracterizado por sintomas recorrentes de ansiedade em pacientes com ou sem doença cardiovascular. O Questionário de Ansiedade Cardíaca (QAC) é uma ferramenta para avaliar a AC, já adaptado, mas não validado em português. OBJETIVO: Este trabalho apresenta as três fases dos estudos de validação do QAC brasileiro. MÉTODOS: Foram recrutados 98 pacientes com doença arterial coronária, a fim de extrair a estrutura fatorial e avaliar a confiabilidade do QAC (fase 1). O objetivo da fase 2 foi explorar a validade convergente e divergente. Cinquenta e seis pacientes completaram o QAC, juntamente com o Escala de sensações corporais (ESC) e o Versão brasileira do Social Phobia Inventory (SPIN). Para determinar a validade discriminante (fase 3), comparamos os escores do QAC de dois subgrupos formados por pacientes da fase 1 (n = 98), de acordo com os diagnósticos de transtorno do pânico e agorafobia obtidos com o MINI - Mini International Neuropsychiatric Interview (Mini Entrevista Neuropsiquiátrica Internacional). RESULTADOS: A solução de dois fatores foi a mais interpretável (46,4% da variância). As subescalas foram denominadas de "Medo e Hipervigilância" (n = 9; alfa = 0,88) e "Evitação" (n = 5; alfa = 0,82). Foi encontrada correlação significativa do fator 1 com o escore total do ESC (p < 0,01), mas não com o fator 2. Os fatores do SPIN apresentaram correlações significativas com as subescalas do QAC (p < 0,01). Na fase 3, os escores dos pacientes "Cardíacos com pânico" foram significativamente maiores no fator 1 do QAC (t = -3,42; p < 0,01, IC = -1,02 a -0,27), e maiores, mas não significativamente diferentes, no fator 2 (t = -1,98; p = 0,51, IC = -0.87 a 0,00). CONCLUSÕES: Os presentes resultados fornecem uma versão final brasileira validada do QAC adequada aos contextos clínicos e de pesquisa.

BACKGROUND: Cardiac Anxiety (CA) is the fear of cardiac sensations, characterized by recurrent anxiety symptoms, in patients with or without cardiovascular disease. The Cardiac Anxiety Questionnaire (CAQ) is a tool to assess CA, already adapted but not validated to Portuguese. OBJECTIVE: This paper presents the three phases of the validation studies of the Brazilian CAQ. METHODS: To extract the factor structure and assess the reliability of the CAQ (phase 1), 98 patients with coronary artery disease were recruited. The aim of phase 2 was to explore the convergent and divergent validity. Fifty-six patients completed the CAQ, along with the Body Sensations Questionnaire (BSQ) and the Social Phobia Inventory (SPIN). To determine the discriminative validity (phase 3), we compared the CAQ scores of two subgroups formed with patients from phase 1 (n = 98), according to the diagnoses of panic disorder and agoraphobia, obtained with the MINI - Mini International Neuropsychiatric Interview. RESULTS: A 2-factor solution was the most interpretable (46.4% of the variance). Subscales were named "Fear and Hypervigilance" (n=9; alpha = 0.88), and "Avoidance", (n = 5; alpha = 0.82). Significant correlation was found between factor 1 and the BSQ total score (p<0.01), but not with factor 2. SPIN factors showed significant correlations with CAQ subscales (p < 0.01). In phase 3, "Cardiac with panic" patients scored significantly higher in CAQ factor 1 (t = -3.42; p < 0.01, CI = -1.02 to -0.27), and higher, but not significantly different, in factor 2 (t = -1.98; p = 0.51, CI = -0.87 to 0.00). CONCLUSIONS: These results provide a definite Brazilian validated version of the CAQ, adequate to clinical and research settings.

Brazilian Portuguese validated version of the Cardiac Anxiety Questionnaire.

BACKGROUND: Cardiac Anxiety (CA) is the fear of cardiac sensations, characterized by recurrent anxiety symptoms, in patients with or without cardiovascular disease. The Cardiac Anxiety Questionnaire (CAQ) is a tool to assess CA, already adapted but not validated to Portuguese. OBJECTIVE: This paper presents the three phases of the validation studies of the Brazilian CAQ. METHODS: To extract the factor structure and assess the reliability of the CAQ (phase 1), 98 patients with coronary artery disease were recruited. The aim of phase 2 was to explore the convergent and divergent validity. Fifty-six patients completed the CAQ, along with the Body Sensations Questionnaire (BSQ) and the Social Phobia Inventory (SPIN). To determine the discriminative validity (phase 3), we compared the CAQ scores of two subgroups formed with patients from phase 1 (n = 98), according to the diagnoses of panic disorder and agoraphobia, obtained with the MINI - Mini International Neuropsychiatric Interview. RESULTS: A 2-factor solution was the most interpretable (46.4% of the variance). Subscales were named "Fear and Hypervigilance" (n=9; alpha = 0.88), and "Avoidance", (n = 5; alpha = 0.82). Significant correlation was found between factor 1 and the BSQ total score (p<0.01), but not with factor 2. SPIN factors showed significant correlations with CAQ subscales (p < 0.01). In phase 3, "Cardiac with panic" patients scored significantly higher in CAQ factor 1 (t = -3.42; p < 0.01, CI = -1.02 to -0.27), and higher, but not significantly different, in factor 2 (t = -1.98; p = 0.51, CI = -0.87 to 0.00). CONCLUSIONS: These results provide a definite Brazilian validated version of the CAQ, adequate to clinical and research settings.

Longitudinal treatment mediation of traditional cognitive behavioral therapy and acceptance and commitment therapy for anxiety disorders.

OBJECTIVE: To assess the relationship between session-by-session putative mediators and treatment outcomes in traditional cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for mixed anxiety disorders. METHOD: Session-by-session changes in anxiety sensitivity and cognitive defusion were assessed in 67 adult outpatients randomized to CBT (n = 35) or ACT (n = 32) for a DSM-IV anxiety disorder. RESULTS: Multilevel mediation analyses revealed significant changes in the proposed mediators during both treatments (p < .001, d = .90-1.93), with ACT showing borderline greater improvements than CBT in cognitive defusion (p = .05, d = .82). Anxiety sensitivity and cognitive defusion both significantly mediated post-treatment worry; cognitive defusion more strongly predicted worry reductions in CBT than in ACT. In addition, cognitive defusion significantly mediated quality of life, behavioral avoidance, and (secondary) depression outcomes across both CBT and ACT (p < .05, R(2) change = .06-.13), whereas anxiety sensitivity did not significantly mediate other outcomes. CONCLUSIONS: Cognitive defusion represents an important source of therapeutic change across both CBT and ACT. The data offered little evidence for substantially distinct treatment-related mediation pathways.

Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders.

OBJECTIVE: Randomized comparisons of acceptance-based treatments with traditional cognitive behavioral therapy (CBT) for anxiety disorders are lacking. To address this gap, we compared acceptance and commitment therapy (ACT) to CBT for heterogeneous anxiety disorders. METHOD: One hundred twenty-eight individuals (52% female, mean age = 38, 33% minority) with 1 or more DSM-IV anxiety disorders began treatment following randomization to CBT or ACT; both treatments included behavioral exposure. Assessments at pre-treatment, post-treatment, and 6- and 12-month follow-up measured anxiety-specific (principal disorder Clinical Severity Ratings [CSRs], Anxiety Sensitivity Index, Penn State Worry Questionnaire, Fear Questionnaire avoidance) and non-anxiety-specific (Quality of Life Index [QOLI], Acceptance and Action Questionnaire-16 [AAQ]) outcomes. Treatment adherence, therapist competency ratings, treatment credibility, and co-occurring mood and anxiety disorders were investigated. RESULTS: CBT and ACT improved similarly across all outcomes from pre- to post-treatment. During follow-up, ACT showed steeper linear CSR improvements than CBT (p < .05, d = 1.26), and at 12-month follow-up, ACT showed lower CSRs than CBT among completers (p < .05, d = 1.10). At 12-month follow-up, ACT reported higher AAQ than CBT (p = .08, d = 0.42; completers: p < .05, d = 0.56), whereas CBT reported higher QOLI than ACT (p < .05, d = 0.42). Attrition and comorbidity improvements were similar; ACT used more non-study psychotherapy at 6-month follow-up. Therapist adherence and competency were good; treatment credibility was higher in CBT. CONCLUSIONS: Overall improvement was similar between ACT and CBT, indicating that ACT is a highly viable treatment for anxiety disorders.

The Believability of Anxious Feelings and Thoughts Questionnaire (BAFT): a psychometric evaluation of cognitive fusion in a nonclinical and highly anxious community sample.

Cognitive fusion--or the tendency to buy into the literal meaning of thoughts, feelings, and bodily sensations--plays an important role in the etiology and maintenance of anxiety disorders and figures prominently in third-generation behavior therapies such as acceptance and commitment therapy (ACT). Nonetheless, there is a lack of validated self-report measures of cognitive fusion/defusion, particularly in the area of anxiety disorders. We attempted to fill this gap with the development and validation of a self-report cognitive fusion measure, the Believability of Anxious Feelings and Thoughts Questionnaire (BAFT), in both a healthy undergraduate sample (N = 432) and highly anxious community sample (N = 503) undergoing a 12-week online ACT intervention. Results suggested a hierarchical factor structure of the BAFT with three lower order factors and one hierarchical factor and excellent internal consistency for the total BAFT score (i.e., αs = .90 and .91 for the undergraduate and highly anxious samples, respectively) and for its factors. Additionally, the BAFT and all of its factors consistently showed strong construct validity with other relevant process and outcome measures in both samples, strong 12-week test-retest reliability (r = .77) in our highly anxious waitlist control subsample and responsiveness to treatment in our highly anxious intervention subsample. These findings suggest that the BAFT is a reliable and valid measure of cognitive fusion in both healthy and clinical populations.

Biological sex and panic-relevant anxious reactivity to abrupt increases in bodily arousal as a function of biological challenge intensity.

An emerging pattern of results from panic-relevant biological challenge studies suggests women respond with greater subjective anxiety than men, but only to relatively abrupt and intense challenge procedures. The current investigation examined the relation between biological sex and self-reported anxious reactivity following biological challenges of varying durations and intensity. Participants were 285 (152 females; M(age) = 21.38; SD = 5.92) nonclinical adults who completed one of three protocols: a 3-min voluntary hyperventilation challenge (VH), a 5-min 10% carbon dioxide-enriched air (CO(2)) challenge, or a 25-s 20% CO(2) challenge. As predicted, results indicated that the 20% CO(2) challenge elicited greater self-reported anxiety than the VH and 10% CO(2) challenges. Moreover, women endorsed greater anxious reactivity than men, but only following the 20% CO(2) challenge. Results are discussed in terms of processes likely to account for sex differences in anxious reactivity following relatively abrupt and intense biological challenges.

Tradução e adaptação transcultural da versão brasileira do Questionário de Ansiedade Cardíaca / Translation and cross-cultural adaptation of the Brazilian Version of the Cardiac Anxiety Questionnaire

INTRODUÇÃO: É crescente a produção científica brasileira na adaptação de instrumentos internacionais para avaliar ansiedade. A tradução e adaptação transcultural de escalas é um primeiro passo na obtenção de instrumentos válidos que permitam a comparação de diferentes populações. O objetivo do presente estudo foi traduzir e avaliar a equivalência semântica do Cardiac Anxiety Questionnaire, realizando um estudo piloto na população brasileira de diferentes níveis de escolaridade. MÉTODO: O processo de adaptação transcultural envolveu duas traduções e retrotraduções realizadas por avaliadores independentes, avaliação das versões e elaboração de uma versão síntese. Também examinamos os comentários dos participantes sobre a versão preliminar do questionário, os quais foram usados no desenvolvimento da versão final. RESULTADOS: Para cada item do instrumento, apresentam-se os resultados das quatro etapas. Os participantes com maior grau de escolaridade não apresentaram dificuldades na compreensão do instrumento, tendo apenas apresentado sugestões controversas acerca do item 5. Entretanto, os participantes apenas com escolaridade em nível fundamental relataram dificuldades com os itens 2, 4, 6, 7, 10, 11 e 14. Algumas alterações semânticas foram realizadas com o intuito de facilitar a compreensão do instrumento. CONCLUSÃO: A utilização de duas versões de tradução e retrotradução, discussão sobre a versão síntese e a interlocução com a população-alvo proporcionaram maior segurança ao processo de equivalência semântica da versão final brasileira.

INTRODUCTION: There has been a growing interest in the cross-cultural application of psychological questionnaires to assess anxiety. The translation and cross-cultural adaptation of the original instrument is the first step in validating an instrument in a new population that will permit comparisons between different populations. The goals of this study were to translate the Cardiac Anxiety Questionnaire, assess its semantic equivalence, and perform a preliminary test with participants from the Brazilian population that were drawn from different educational backgrounds. METHOD: The cross-cultural adaptation process consisted of two translations and back translations performed by two independent evaluators; a critical evaluation of the two versions, and the development of a synthesized version. We also examined comments provided by participants on the preliminary version of the questionnaire and used them for the development of the final version. RESULTS: We report the results of the four stages for each item of the instrument. Participants with tertiary education had no difficulties comprehending the translated items of the questionnaire, only pointing item 5 as ambiguous. Participants from the lower educational level reported comprehension problems regarding items 2, 4, 6, 7, 10, 11 and 14. Some small changes were made in our first version to enhance comprehensibility. CONCLUSION: The use of two versions of translations, a critical examination of the two versions, and suggestions made by participants resulted in a final Brazilian version with a satisfactory degree of semantic accuracy and semantic equivalence with the original version.

Cardiophobia: a critical analysis.

Cardiophobia, a clinical syndrome that affects hundreds of thousands of individuals in the USA, is characterized by abrupt, recurrent sensations and pain in the chest in the absence of physical pathology. This conceptual article seeks to address the significance of cardiophobia in western culture and to distinguish it from related disorders. In addition, a model of cardiophobia that highlights the role of heart-focused anxiety and interoceptive conditioning in the generation of limited-symptom panic attacks and acute chest pain is presented and vulnerability factors for cardiophobia are discussed. Future research directions relevant to the assessment and treatment of this clinically significant phenomenon are reviewed.

Heart-focused anxiety before and after cardiac surgery.

OBJECTIVE: We investigated the degree and course of heart-focused anxiety (HFA) in patients with cardiac diseases before and after cardiac surgery. METHODS: We examined 90 patients undergoing coronary bypass, valve replacement, or combined surgery before surgery, 6 weeks after surgery, and 6 months after surgery. Patients completed the Cardiac Anxiety Questionnaire (CAQ), which assesses heart-focused fear, attention, and avoidance, and a set of other questionnaires assessing general anxiety, depression, and quality of life. Data were compared with an age- and sex-controlled contrast group of 72 orthopedic patients with no history of cardiac disease. RESULTS: All dimensions of HFA were elevated in patients before surgery. CAQ-Fear was significantly reduced 6 weeks after surgery and at 6-month follow-up. CAQ-Avoidance was stable after surgery but declined on follow-up, while there was only a statistical tendency indicating reduction in CAQ-Attention. Approximately 20% of patients continued to experience clinically elevated levels of HFA at 6-month follow-up. Furthermore, we found decreases in global anxiety and depression, and an increase in quality of life after surgery. CONCLUSIONS: In contrast to global psychosocial indicators, the more specific assessment of HFA may help identify individuals with elevated levels of HFA who might benefit from interventions to help them adjust to the effects of surgery and lingering cardiac problems.

Taxonicity of anxiety sensitivity: a multi-national analysis.

Taxometric coherent cut kinetic analyses were used to test the latent structure of anxiety sensitivity in samples from North America (Canada and United States of America), France, Mexico, Spain, and The Netherlands (total n = 2741). Anxiety sensitivity was indexed by the 36-item Anxiety Sensitivity Index--Revised (ASI-R; [J. Anxiety Disord. 12(5) (1998) 463]). Four manifest indicators of anxiety sensitivity were constructed using the ASI-R: fear of cardiovascular symptoms, fear of respiratory symptoms, fear of publicly observable anxiety reactions, and fear of mental incapacitation. Results from MAXCOV-HITMAX, internal consistency tests, analyses of simulated Monte Carlo data, and a MAMBAC external consistency test indicated that the latent structure of anxiety sensitivity was taxonic in each of the samples. The estimated base rate of the anxiety sensitivity taxon differed slightly between nations, ranging from 11.5 to 21.5%. In general, the four ASI-R based manifest indicators showed high levels of validity. Results are discussed in relation to the conceptual understanding of anxiety sensitivity, with specific emphasis on theoretical refinement of the construct.

Avoidance-oriented coping as a predictor of panic-related distress: a test using biological challenge.

The present experimental psychopathology study sought to investigate the extent to which pre-experimental levels of avoidance-oriented coping predict anxious and fearful responding during acute physical stress, relative to other theoretically relevant variables. Participants included 80 individuals with no known history of psychological or physical health problems. Dependent measures include self-reported anxiety, DSM-IV panic symptoms, and physiological indices of heart rate and skin conductance. Consistent with our hypotheses, the tendency to engage in avoidance-oriented coping predicted increased physical panic symptoms and self-reported anxiety elicited by biological challenge, relative to specific anxiety sensitivity (AS) dimensions. These findings are discussed in terms of how specific types of coping are associated with prototypical indices of panic distress, with implications for forwarding future work on emotional regulation in panic disorder.