A Comparison of Reinforcement Sensitivity Theory Measures: Unique Associations With Social Interaction Anxiety and Social Observation Anxiety.

Evidence suggests that the behavior inhibition system (BIS) and fight-flight-freeze system play a role in the individual differences seen in social anxiety disorder; however, findings concerning the role of the behavior approach system (BAS) have been mixed. To date, the role of revised reinforcement sensitivity theory (RST) subsystems underlying social anxiety has been measured with scales designed for the original RST. This study examined how the BIS, BAS, and fight, flight, freeze components of the fight-flight-freeze system uniquely relate to social interaction anxiety and social observation anxiety using both a measure specifically designed for the revised RST and a commonly used original RST measure. Comparison of regression analyses with the Jackson-5 and the commonly used BIS/BAS Scales revealed important differences in the relationships between RST subsystems and social anxiety depending on how RST was assessed. Limitations and future directions for revised RST measurement are discussed.

Confirmatory factor and measurement invariance analyses of the emotion regulation questionnaire.

Emotion regulation is widely studied in many areas of psychology and the number of publications on emotion regulation has increased exponentially over the past few decades. Additionally, interest in the relationships between emotion dysregulation processes and psychopathology has drastically increased in recent years. The Emotion Regulation Questionnaire (ERQ) was developed to measure two specific constructs related to emotion control: reappraisal and suppression (Gross & John, 2003). In its initial validation study and subsequent analyses, the instrument was shown to possess sound psychometric properties, but, to date, inquiry regarding the measure's characteristics has been limited. Factor analytic examinations of commonly used instruments are recommended to validate the properties of a given measure and increase researchers understanding of the measured constructs. The current study examined the psychometric properties of the ERQ in a sample of 1,188 undergraduates through confirmatory factor analysis. Additionally, tests of measurement invariance were employed in order to examine potential structural differences based on gender and ethnicity. The current study supported the original structure of the measure with all demographic groups and exceptional fit was demonstrated. Additional normative data for gender and ethnic groups are included. Results support the use of the instrument in future research.

Psychometric properties of the Liebowitz Social Anxiety Scale (LSAS) in a longitudinal study of African Americans with anxiety disorders.

The Liebowitz Social Anxiety Scale (LSAS) is a widely used measure of social anxiety. However, no study has examined the psychometric properties of the LSAS in an African American sample. The current study examined the LSAS characteristics in 97 African Americans diagnosed with an anxiety disorder. Overall, the original LSAS subscales showed excellent internal consistency and temporal stability. Similar to previous reports, fear and avoidance subscales were so highly correlated that they yielded redundant information. Confirmatory factor analyses for three previously proposed models failed to demonstrate an excellent fit to our data. However, a four-factor model showed minimally acceptable fit. Overall, the LSAS performed similarly in our African American sample as in previous European American samples. Exploratory factor analyses are warranted to determine whether a better factor structure exists for African Americans.

Path analytic examination of a cognitive model of PTSD.

Ehlers and Clark (2000) developed a cognitive model of posttraumatic stress disorder (PTSD) symptom maintenance which implicated the role of posttraumatic cognitions and aspects of the trauma memory in maintaining symptoms via an increased sense of current threat. The aim of the current study was to empirically test a variant of this model using path analysis. Participants in the current study were 514 undergraduates at a midwestern university who reported experiencing at least one traumatic event. Path analyses examined various models of the possible relationships between one's posttraumatic cognitions and the centrality of the traumatic event to the sense of self (considered an aspect of memory integration) in predicting current level of PTSD symptoms. Results indicate that both event centrality and posttraumatic cognitions are unique and independent predictors of current symptom level. Overall, the results of this study support aspects of Ehlers and Clark's cognitive model of PTSD; cognitive appraisals of the self and centrality of the event were highly related to levels of distress. However, the current study suggests that overly integrated trauma memories may lead to greater distress and not poorly integrated ones as suggested by Ehlers and Clark.

WITHDRAWN: Path analytic examination of a cognitive model of PTSD.

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Social anxiety across ethnicity: a confirmatory factor analysis of the FNE and SAD.

Previous research has established that social anxiety occurs at different rates in African American and European American populations (Grant et al., 2005), while psychometric investigations of widely used measures of psychopathology show differences in factor structure based on ethnic background (Carter, Miller, Sbrocco, Suchday, & Lewis, 1999; Chapman, Williams, Mast, & Woodruff-Borden, 2009). The current study examined response characteristics of 1276 African American and European American undergraduates completing the Fear of Negative Evaluation and Social Avoidance and Distress Scales (Watson & Friend, 1969). Confirmatory factor analyses failed to demonstrate factorial invariance in the two ethnic samples, and Wald tests suggested several items on both measures be dropped for African Americans. Results suggest the FNE and SAD operate differently across ethnic groups. Implications for the cross-cultural measurement of social anxiety and the importance of continued rigorous psychometric inquiry of commonly used measures are discussed.

An examination of the differential effects of the experience of DSM-IV defined traumatic events and life stressors.

Recent evidence suggests that individuals exposed to traumatic events report similar, if not lower, levels of posttraumatic stress disorder (PTSD) symptoms than individuals exposed to nontraumatic stressful life events [J. Anxiety Disord. 19 (2005) 687-698; Br. J. Psychiatry 186 (2005) 494-499]. The current study compared the level of self-reported PTSD symptoms in a large sample (n=668) of trauma and nontrauma exposed college students. Participants were assessed for past trauma history as well as current symptoms of PTSD, depression, social interaction anxiety, and current positive and negative affect. Results indicated that while those who had experienced a traumatic event reported statistically significantly higher levels of PTSD symptoms, these differences were no longer clinically significant after other psychological distress factors were accounted for. Additional analyses suggested that those who had experienced events of an interpersonal nature had significantly higher levels of PTSD symptoms than those who had experienced other types of events.

A factor analytic comparison of five models of PTSD symptoms.

This study examined the factor structure of PTSD symptoms in a sample of college students (n=344) reporting exposure to a range of traumatic events. The sample was randomly split and an exploratory factor analysis was conducted with half of the sample. The factor structure obtained in the exploratory analysis was evaluated against three other models using confirmatory factor analysis utilizing the second half of the sample. This series of factor analyses identified and confirmed a three-factor symptom structure consisting of intrusion/avoidance, dysphoria, and hyperarousal clusters. These results add to the body of literature which has found that PTSD includes a cluster of symptoms shared with other diagnoses (dysphoria) and a more specific factor related directly to the effects of encountering traumatic experiences.

Impact of parental history of substance use disorders on the clinical course of anxiety disorders.

BACKGROUND: Among the psychological difficulties seen in children of parents with substance use problems, the anxiety disorders are among the most chronic conditions. Although children of alcoholic parents often struggle with the effects of parental substance use problems long into adulthood, empirical investigations of the influence of parental substance use disorders on the course of anxiety disorders in adult offspring are rare. The purpose of this study was to examine prospectively the relationship between parental substance use disorders and the course of anxiety disorders in adulthood over the course of 12 years. METHODS: Data on 618 subjects were derived from the Harvard/Brown Anxiety Research Project (HARP), a longitudinal naturalistic investigation of the clinical course of multiple anxiety disorders. Kaplan-Meier survival estimates were used to calculate probabilities of time to anxiety disorder remission and relapse. Proportional hazards regressions were conducted to determine whether the likelihood of remission and relapse for specific anxiety disorders was lower for those who had a history of parental substance use disorders than for individuals without this parental history. RESULTS: Adults with a history of parental substance use disorders were significantly more likely to be divorced and to have a high school level of education. History of parental substance use disorder was a significant predictor of relapse of social phobia and panic disorders. CONCLUSION: These findings provide compelling evidence that adult children of parents with substance use disorders are more likely to have relapses of social phobia and panic disorders. Clinicians who treat adults with anxiety disorders should assess parental substance use disorders and dependence histories. Such information may facilitate treatment planning with regards to their patients' level of vulnerability to perceive scrutiny by others in social situations, and ability to maintain a long-term panic-free state.

Differing effects of partner and nonpartner sexual assault on women's mental health.

This study contrasted the effects of intimate partner and nonpartner sexual assault on women's mental health among a sample (N=835) of low-income, ethnically diverse community women. Compared to sexual assault by a previous partner or by a non-intimate partner, sexual assault by a current partner was the strongest predictor of PTSD, stress, and dissociation. Non-intimate partner sexual assault was only a significant predictor of PTSD and only for African American women. These findings suggest that the victim-offender relationship is important when considering the impact of sexual assault. Specifically, sexual assault perpetrated by an intimate partner may be especially traumatic.

The structure of worry: relations between positive/negative personality characteristics and the Penn State Worry Questionnaire.

The present studies investigated the structure, correlates, and predictors of worry, as assessed by the Penn State Worry Questionnaire (PSWQ), in a large nonclinical sample (N=1439). Exploratory factor analysis of the PSWQ in Study 1 revealed a two-factor solution (Worry Engagement and Absence of Worry). Confirmatory factor analysis in Study 2 indicated that the two-factor solution provided a better fit to the data than a one-factor model. The PSWQ and its factors evidenced good internal consistency, and correlations with measures of positive and negative state-trait variables provided evidence for good convergent and discriminant validity in both studies. Evidence for the specificity of the two-factor solution was also found such that the Worry Engagement factor demonstrated higher correlations with negative state-trait variables than the Absence of Worry factor. However, path analyses in Study 3 examining predictors of worry provided support for a one-factor solution to the PSWQ. Furthermore, path analyses showed that trait anxiety significantly mediated the relationship between negative characteristics and worry, whereas trait anxiety inversely mediated the relationship between positive characteristics and worry. These findings support the use of the PSWQ in research examining the nature of worry and highlight how positive and negative characteristics may have unique relations with worry in the context of trait anxiety.

Psychometric characteristics of the Mobility Inventory in a longitudinal study of anxiety disorders: replicating and exploring a three component solution.

Psychometric characteristics of the Mobility Inventory (MI) were examined in 216 outpatients diagnosed with panic disorder with agoraphobia participating in a longitudinal study of anxiety disorders. An exploratory principal components analysis replicated a three-component solution for the MI reported in prior studies, with components corresponding to avoidance of public spaces, avoidance of enclosed spaces, and avoidance of open spaces. Correlational analyses suggested that the components tap unique but related areas of avoidance that were remarkably stable across periods of 1, 3, and 5 years between administrations. Implications of these results for future studies of agoraphobia are discussed.

Religious coping research and contemporary personality theory: an exploration of Endler's (1997) integrative personality theory.

Notable weaknesses in the literature on religion and mental health include theoretical inconsistencies and lack of integration with contemporary personality theory. The current study explored a potential solution to these theoretical limitations. A modified form of Endler's (1997) interactive model of personality was applied to the prediction of religious coping and tested using structural equation modelling. As predicted by the model, personality dispositions predicted coping directly, as well as indirectly through perception of the situation and situational anxiety. These patterns were, as expected, found to interact with the type of situation. Results indicated that having a positive disposition appears to buffer one's negative perceptions of situations over which one has little control. Participants tended to use more religious coping in low-control situations; in high-control situations, participants tended not to use negative religious coping techniques such as pleading for miracles.

Characteristics and predictors of full and partial recovery from generalized anxiety disorder in primary care patients.

The current study examined the naturalistic course of generalized anxiety disorder (GAD) in a sample of 113 primary care patients across a 2-year period. Initial diagnoses were established using structured clinical interviews according to DSM-IV diagnostic criteria. Results indicated that the majority of patients meeting DSM-IV diagnostic criteria for GAD were still symptomatic to some degree after 2 years of follow-up. Rates of full and partial recovery from GAD, however, were found to be higher than those reported for previous studies of GAD in psychiatric patients. Diagnostic comorbidity, severity of psychosocial impairment, and gender were found to be significantly associated with achieving full or partial recovery from GAD. Psychiatric treatment was not found to be associated with time to full or partial recovery from GAD symptoms, likely due to a treatment-biasing effect. These results underscore that GAD is a chronic and persistent illness in primary care patients.

The role of emotional functioning in military-related PTSD and its treatment.

This two-part study investigated the cross-sectional and across-treatment relationships among measures of emotional functioning and posttraumatic stress disorder (PTSD) symptomatology for veterans receiving specialized treatment for military-related PTSD. Cross-sectional analyses revealed overlap among emotion regulation, affective control, depressive symptoms, and PTSD symptoms at pre-treatment. In regression analyses, fear of losing affective control was most predictive of PTSD symptoms. Bivariate analyses of residualized change scores showed that changes in emotion regulation and fear of losing affective control were associated with changes in PTSD and depressive symptoms across treatment. Regression analyses revealed that changes in fear of losing affective control most strongly predicted changes in PTSD and depressive symptoms. Theoretical and clinical implications are discussed, including an understanding of the differences between emotion regulation and affective control processes. Future research directions are offered, including improved measurement of emotional functioning and longitudinal research delineating the likely bi-directional relationship between emotional functioning and PTSD.

Long-term use of benzodiazepines in participants with comorbid anxiety and alcohol use disorders.

BACKGROUND: Although the only widely accepted role for benzodiazepines in alcohol dependence is the treatment of withdrawal syndromes, they are frequently prescribed outside of this clinical setting. There is little empirical evidence to guide the rational use of benzodiazepines in the common clinical situation where anxiety disorders are comorbid with alcohol use disorders (AUD). Since January 1989, the Harvard Anxiety Research Program has naturalistically monitored the prospective clinical course of people with anxiety disorders, some of whom had a history of AUD. Earlier research showed that the use of benzodiazepines was not significantly associated with the presence or absence of a history of an AUD over the first year of follow-up. This report extends that investigation. METHODS: Using standard parametric analytic methods, patterns of benzodiazepine use (routinely prescribed medication and as-needed [PRN] use) among participants receiving benzodiazepine treatment was prospectively examined over the course of 12 years. Differences in benzodiazepine usage patterns were examined in each year of follow-up between participants who did (n=120) and did not (n=425) have a new episode of AUD. Using proportional hazards regression analysis, benzodiazepine usage levels were examined as predictors of recovery and recurrence of AUD. Additionally, random-effects regression analyses were used to examine the patterns of benzodiazepine use before and after the onset of a prospectively observed episode of AUD. RESULTS: Benzodiazepine usage levels remained stable for the full sample over the course of the 12 years. Benzodiazepine use did not distinguish participants who had a new AUD from those who did not. Over the 12 years of follow-up, participants who had an AUD used more PRN medication in years five to eight. This difference reached statistical significance but was not clinically significant. Benzodiazepine usage levels did not predict recovery or recurrence in AUD subjects. Neither the total dose nor the PRN usage of benzodiazepines was significantly associated with the onset of AUD, but when combined into a measure of any benzodiazepine use, a relationship between increased use and the onset of AUD emerged. CONCLUSIONS: For participants in the Harvard Anxiety Research Program with comorbid alcohol dependence and anxiety disorders, there was little association between the use of benzodiazepines and the occurrence of a new AUD. Neither was there a temporal relationship between the use of benzodiazepines and the onset of a new AUD. Whether or not this finding extends to a broader patient population or a group of people who present to addictions treatment awaits further investigation.

Relationships among psychosocial functioning, diagnostic comorbidity, and the recurrence of generalized anxiety disorder, panic disorder, and major depression.

The present study examined the relationships among impaired psychosocial functioning, comorbidity, and the cumulative probability of future recurrence of anxiety disorders and major depression in recovered patients. Participants were part of the Harvard/Brown Anxiety Disorders Research Program (HARP), a naturalistic, prospective, longitudinal study of anxiety disorders in psychiatric outpatients. Using proportional hazards regressions, worsening psychosocial impairment in general and in specific areas was significantly associated with an increased risk of panic disorder, generalized anxiety disorder, and major depression recurring, even after controlling for diagnostic comorbidity. These results are consistent with and extend similar findings for patients with major depression [Leon, A., Solomon, D. A., Mueller, T. I., Endicott, J., Posternak, M., Judd, L. L., et al. (1999). The range of Impaired Functioning Tool (LIFE-RIFT): a brief measure of functional impairment. Psychological Medicine, 29, 869-878; Leon, A., Solomon, D. A., Mueller, T. I., Endicott, J., Posternak, M., Judd, L. L., et al. (2000). A brief assessment of psychosocial functioning of subjects with bipolar I disorder: The LIFE-RIFT. The Journal of Nervous and Mental Disease, 188, 805-812], and suggest that increased psychosocial impairment may be a risk factor for relapse.

Cognitive-behavioral therapy for PTSD in the real world: do interpersonal relationships make a real difference?

The goal of this effectiveness study was to investigate the role of pre-treatment interpersonal relationship functioning in two forms of group cognitive-behavioral treatment (CBT) for veterans with PTSD. Analysis of data from 45 veterans who completed either trauma- or skills-focused CBT indicated no overall differences between the two treatments in PTSD symptomatology, alcohol abuse, or violence perpetration at four months post-treatment. However, there was a stronger inverse relationship between intimate relationship functioning and violence outcomes in the trauma-focused group versus the skills-focused group. While no differences in violence outcomes were found between the treatments at poorer levels of pre-treatment intimate relationship functioning, those receiving trauma-focused treatment with better pre-treatment intimate relationships reported less violence. Extended relationship functioning and violence outcomes were less strongly associated in the trauma-focused group versus the skills-focused group. The theoretical implications of these results, as well as the clinical opportunities to improve CBT for PTSD by capitalizing on patients' relationships, are discussed.

Emotional deficits in military-related PTSD: an investigation of content and process disturbances.

To expound on the nature of emotional deficits in PTSD, the current study investigated the relationships among emotion content and process variables and PTSD symptomatology in a sample of 85 veterans with military-related trauma. Alexithymic externally oriented thinking and negative affectivity emerged as the most consistent predictors of PTSD symptoms; however, depression was the only variable associated with emotional numbing. Theoretical and clinical implications of these findings are discussed, as well as future research directions including the collateral and clinician assessment of emotional functioning, use of other process measures, and inclusion of various control groups.

Frequency and patterns of psychiatric comorbidity in a sample of primary care patients with anxiety disorders.

The current report examines the rates of psychiatric comorbidity in a sample of 539 primary care patients diagnosed with anxiety disorders using the Structured Clinical Interview for DSM-IV (SCID-IV). Though not a typical psychiatric sample, rates of comorbidity were found to be as high or higher than those reported in studies conducted in traditional mental health settings. Multiple anxiety disorders were diagnosed in over 60% of participants and over 70% of participants had more than one current axis I diagnosis. Rates of current and lifetime comorbid major depression were also very high. Patterns of diagnostic comorbidity were also examined, with significantly elevated risks for the co-occurrence of several specific pairings of disorders being found. The study results are discussed in context of a recently published, large-scale study of anxiety disorder comorbidity in psychiatric patients (Brown et al., 2001). Implications of these results for both the mental health and primary care fields are also discussed.