La experiencia y expresión de la ansiedad y la ira en pacientes con asma bronquial / The experience and expression of anger and anxiety in Bronchial asthma patients

Este estudio investigó las diferencias entre un grupo de personas con asma bronquial y un grupo de personas sanas en sus respuestas a diferentes medidas de ansiedad rasgo y de la experiencia, expresión y control de la ira. El Inventario de Situaciones y Respuestas de Ansiedad (ISRA) y la adaptación española del Inventario de Expresión Estado-Rasgo de la Ira (STAXI) fueron administradas a pacientes con asma bronquial y a un grupo de personas sanas, equiparadas en edad y sexo. Los pacientes con asma mostraron niveles significativamente mayores de ansiedad rasgo, mayor ansiedad fisiológica y motora, más pensamientos de inseguridad, así como mayor ansiedad en las diferentes áreas situacionales evaluadas. Igualmente, los pacientes con asma experimentaron ira con mayor frecuencia que los controles sanos, con y sin provocación, informando de mayores puntuaciones en rasgo de ira, temperamento de ira, e ira externa. Estos resultados añaden evidencias de la importancia del manejo de las emociones negativas en el tratamiento de los pacientes con asma bronquial (AU)

This study investigated differences between asthma patients and a control group of healthy individuals in their responses to eight measures of trait anxiety and the experience, expression and control of anger. The Inventory of Situations and Responses of Anxiety (ISRA) and a Spanish adaptation of State-Trait Anger Expression Inventory (STAXI) were administered to medical outpatients diagnosed as suffering from bronchial asthma and a control group of healthy persons closely matched for age and gender. Asthma patients had significantly higher ISRA trait anxiety scores, reported more physiological and motor anxiety, thoughts of insecurity, as well as more anxiety in relation to four different situational areas. The asthma patients also reported experiencing anger more frequently, and without provocation, than healthy persons as reflected in higher STAXI T-Anger, Angry Temperament, and Anger-Out scores. These results provide evidence of the importance of dealing with negative emotions in the treatment of bronchial asthma patients (AU)

Chilean experimental version of the State-Trait Depression Questionnaire (ST-DEP): State subscale (S-DEP).

Depression is the most prevalent mental disorder and one of the most important health problems in Chile. The current study shows data for validity and reliability of the State subscale (S-DEP) of the Chilean experimental version of the State-Trait Depression Questionnaire (ST-DEP). The procedure conducted with the original version of the questionnaire was replicated on a sample of 300 university students. The utilized measures were the State Depression Questionnaire, Beck Depression Inventory, the State-Trait Anxiety Inventory, and neutral depressive, mild depressive, and moderate depressive vignettes. Results indicated that the factor structure was replicable, the internal consistency was good, and the situations were ranked as expected. The scale distinguishes intensities of depression. Clinicians and researchers in Chile are provided with a new measure for state depression.

Análisis preliminar y datos normativos del Cuestionario de Ansiedad Estado-Rasgo en adolescentes y adultos de la ciudad de Santiago de Chile / Preliminary analysis and normative Data of the State-Trait Anxiety Inventory (STAI) in adolescent and adults of Santiago, Chile

El estudio reporta los análisis preliminares y datos normativos, para una muestra de población general del Cuestionario de Ansiedad Estado Rasgo (Spielberger, Gorsuch & Lushene, 1970). Los datos fueron obtenidos de una muestra total de 1488 personas entre 13 y 60 años de edad. La consistencia interna obtenida fue .92, para STAI-S y .87 para STAI-R. Del análisis factorial confirmatorio se obtienen dos factores para cada escala. Finalmente, se realizan análisis de comparación de medias para la obtención de datos normativos, para la muestra total diferenciada por sexo y para la muestra de adolescentes y adultos.

The present study reports the preliminary analyses and normative data of the State-Trate anxiety inventory (Spielberger, Gorusch & Lushene, 1970), for a Chilean, general population sample. Data were obtained from a total sample of 1488 people, between 13 and 60 years old. A high internal consistency for STAI-S .92 and for STAI-T .87 is reported. Two factors were obtained from the confirmatory factorial analysis. Finally, analyses of the means were carried out, obtaining normative data for the total sample, differentiated by sex, and for the adolescents and adults sample.

La depresión: ¿un trastorno dimensional o categorial?

resumen está disponible en el texto completo

Summary One of the crucial subjects, either for the clinical or scientific activity, is the dimensional or categorical character of depression and other mental diseases. Each approach is different from the theoretical and epistemological points of view. At presence, the categorical model for the definition and estimation of the presence of a disorder are reflected in the data on epidemiology, the results of investigations, instruments and the interventions. These elements are related to a system of thinking which results in a particular form of conceiving the psychopathology and intervention. Nevertheless, the strong influence of the categorical model in which the disorders are defined as a group of accomplished criteria has not prevented from development of a dimensional model. The latter postulates the existence of a continuum between the normality and pathology which correspond with dimensions, levels and severity related to the certain behaviours, traits or even symptoms. The interest in the dimensional approach to psychopathology, in general and in mood disorders, is caused by the observation in clinics which indicate, for example, that many patients do not improve with medicines and present residual symptoms during long periods of time. For these reasons, some personality factors which would explain the chronic symptoms of disorders have been proposed in Psychology and Psychiatry. Although the diagnostic manuals consider different types of mood disorders, many investigations have showed the possibility to consider depression as a continuum, where the least severe extreme would be the depressive personality and the most severe, major depression. According to the abovementioned proposal, it is possible that some people present certain vulnerability which would explain the different answers in case of depression. Cognitive factors, together with social and genetic factors increase the risk of chronic depressive symptoms. The catastrophic perception of self, the world and future, the dichotomous thinking and tunnel vision are the cognitive factors associated with the presence of the mood disorders symptoms. Additionally, some studies show the importance of gender, as women are more prone to develop depression and similar disorders which is related to traditional social roles. This can be caused by the need to sacrifice the professional career to dedicate time to housework, or to assume multiple roles. Concerning the genetic factors, the presence of first degree relatives with mood disorders increases the risk of development of depression or dysthymia. The consideration of depressive personality is based on the presence of symptoms which do not fulfil the criteria of severity and frequency of major depression but do affect the mood. The presence of these stable traits is related to major chronicity and worse prognosis. This condition has been described in manuals as dysthymia. Nevertheless, as it remains relatively stable in time it could be understood as a personality disorder. The disorder would be a continuum with the normality similar to this described as neuroticism in which some entities are qualitatively and quantitatively different which represent the categories. The analysis of what has been described above shows the possibility of differentiation between the mood disorders which are related to the dimensional focus where some traits increase the vulnerability to develop them. On the other hand, the categorical focus requires the accomplishment of the diagnostic criteria. The cognitive models also support the existence of depressive personality disorder. These models emphasize the importance of schemes in thinking which are created in childhood together with the attachment to the caretaker. The schemes are the basis for the future relationships which in case of mood disorders are always perceived with continuous thread of abandonment and lost. On the other hand, the behavioural models emphasize the patterns of negative interpersonal interaction in childhood, as the factors which predispose to the development of depression, whereas the psychodynamic theories establish the successive lost during the lifetime as the principal cause of mood disorders. All these theories show the existence of unfavourable emotional conditions which cause a certain vulnerability to develop symptoms of depression. The dimensional focus on depression is also supported by the evidence on the distinction between the disorders according to the severity. The difference between the normality and the psychopathology is not as clear as in the categorical focus. There is a necessity to develop new forms of evaluation which would enable the differentiation between the stable traits and punctual states of mood. At presence, most of the questionnaires are based on the categorical classification which makes the estimation from the dimensional point of view more difficult. On the other hand, the measures which provide differentiation between the traits and states are an alternative to estimate the stable conditions which would be related to the depressive personality and also specific reactions which depend on the present situation. Most of the instruments have been developed on the basis of the categorical model in which the diagnosis is the presence or absence of a disorder according to the diagnostic criteria. For this reason they do not have sufficient sensitivity to determinate less severe levels which are also important in clinical interventions as they allow the estimation of the improvements and decrease of symptomatology. The dimensional focus allows the preventive interventions in mood disorders which are very important to solve this serious health problem in the population.

Ansiedad y depresión: el problema de la diferenciación a través de los síntomas

resumen está disponible en el texto completo

SUMMARY The differentiation between the symptoms of anxiety and depression is one of the most important problems in psychology as the dilemma profoundly affects the diagnosis and clinical intervention. According to the epidemiological data there is a strong comorbility between the two types of disorder. Nevertheless, it is not known which one of them precedes or predisposes to the other. The comorbility could be also caused by the confusion between the two. There are many common symptoms and some of them traditionally attributed to the anxiety are also present in depression and vice versa. Additionally, in some cases the symptoms themselves could constitute complete clinical charts. Taking into account the above description, one of the most important current preoccupations in psychology and psychopathology is the identification of the symptoms which would be characteristic for each disorder. Although there is clinical evidence on an overlap between the symptoms, the current manuals describe two disorders and the clinical differences are crucial. One of the possible explanations of the overlap between the symptoms of anxiety and depression has been classically attributed to comorbility which means the presence of both charts in many clinical cases. Different sources indicate that the presence of anxiety in early ages can generate certain vulnerability to develop later-age major depression. On the other hand, other studies indicate that the cases in which both, depression and anxiety are present, tend to chronify and are more resistant to treatment. In this case both disorders are present but there is no sufficient evidence to determinate which one of them would be the principal diagnosis and which one would be secondary. For this reason, the explanations are confused and neither the researchers nor clinicians are satisfied. On the other hand, the concurrence of symptoms has been attributed to the instruments utilized for the evaluation. The disorders also depend on the tools for their measure which follow a theoretical model to explain the aetiology, course, prognosis and associated symptomatology. This way, the implicit bias of the instruments is to privilege a specific aspect which depends on the definition of disorders without taking into account the other aspects. According the description above, the evaluation, especially in case of depression, is characterized by multiplicity of instruments and diversity of contents which are evaluated. Thus, it is difficult to establish the characteristic symptoms as in many cases only some of them coincide when utilizing different tools. Moreover, many symptoms which are detected by scales of depression are also present in anxiety disorders. This difficulty is one of the most important problems in clinics as it affects the validity and reliability of the tools which assess the disorders. The importance of the instructions given to the subjects should also be emphasized. In many cases they lead to the confusion of the measures of frequency and severity which is related to the classical discussion about the dimensional or categorical character of depression. Some authors state that the consideration of depression as a dimensional disorder makes possible to understand that some charts, as for example the anxiety disorders, can appear as a consequence of certain vulnerability generated by the depression. One of the alternatives to explain the presence of symptoms shared by the anxiety and depression is to consider the existence of a factor of negative affect which would be present in both types of disorder. This point of view is derived from the correspondence between some common symptoms in depression and anxiety observed in clinics. Additionally, some items included in the self-report questionnaires and scales are the same for the two disorders. The group of symptoms includes sadness, crying, psychomotor restlessness and irritability among others. The factor which includes these symptoms is called negative affect and would be common for the anxiety and depression. Although the negative affect factor is the same for anxiety and depression, some elements are characteristic for one disorder but not for the other. In case of anxiety, according to the tripartite model the characteristic factor refers to high physiological activation related to the vegetative symptoms. On the other hand, in depression, the negative affect is also accompanied by low positive affect which can be seen in the lost of interest in things which were enjoyed before (anhedony). Thus, the anxiety would be defined as high negative affect together with high physiological arousal whereas depression is characterized by high negative affect and low positive affect. For all the reasons described above, the importance of applying adequate and reliable instruments to evaluate the disorders should be emphasized. These instruments would help to clarify the features of each disorder and would support more effective interventions to decrease the rate and incidence of mental disorders in the population. In relation to this, Spielberger et al. offer an instrument which differentiates the aspects characteristic for depression utilizing two different scales: depression as a trait and as a state. The instrument allows the differentiation between the trait and the state which provides the information about the aspects which are more stable and lasting in time related to the mood which probably refer to the personality traits (the trait scale). The aspects which depend more on the punctual moments are measured by the state scale. This is possible thanks to the instructions which evaluate in a different manner the frequency and the severity which are usually confused in most of the scales. The component of negative affect (Dysthymia) which is common for the anxiety and depression is evaluated together with positive affect (Euthymia) and offers the valuation of low affectation levels which are not considered in most of the self-report questionnaires, although they are crucial for the clinical practice and investigation.

Evaluación del componente afectivo de la depresión: análisis factorial del ST/DEP revisado

resumen está disponible en el texto completo

Abstract: Depression is a main Public Health problem due to its high prevalence and to the costs for intervention and treatment. Therefore, it is necessary to identify strategies that allow an adequate assessment that would let us obtain a more precise and useful diagnosis. Nevertheless, animportant obstacle for this task, is a lack of theoretical clarity in regard to diagnostic criteria or, especially, to symptoms which are relevant for depression. This fact is obvious in the scales focused on depression assessment, which have a broad variety of symptoms to assess, and it is possible to overestimate some areas or to underestimate others, related to theoretical criterions which were involved in test construction. So, depression is evaluated in accordance with the questionnaire that is used and, of course, depending of theoretical framework that supports this tool. Therefore, depression is defined in line with the criteria which evaluates it, with regard to assessment s criteria, which could explain the usual difficulty to identify common symptoms when some tools are used, which are then identified as genuine symptoms of depression. As the aim of this paper is to improve some of this limitations, the State/Trait Depression Questionnaire (ST/DEP) is showed as an useful tool for clinical and research work. It offers an assessment of one of the component of depression, the affective one, providing two measures: State and Trait. This allows to differentiate between intensity and frequency. Main-axis factor analysis has been made and the results have shown two main factors in affectivity: Dysthymia (negative affection) and Euthymia (positive affection). The interest on positive affection assessment aims to obtain a more precise tool. So, when scores are inverted in positive items, it is possible to obtain a measurement of low levels on affectation. The relevance of this fact is emphasized because it has been neglected in most of depression scales, that only identify presence or absence, a fact that limits the ability to estimate slight modifications. This issue is very useful at two levels: clinic and research. At a clinical level because it permits to identify slight changes in affectation, which could be important as measurement oftherapeutic efficacyand ofsymptoms remission. In research, because it offers the possibility to dispose of one able tool to differenciate of low levels of affectation, which allow a more accurate estimation of the depression symptoms, specially when working with a nonclinical population. The present study was carried out with a sample of 300 participants (103 males and 197 females), with mean age of 21.82 (2.74 s.d.) for males and 22.26 (3.66 s.d.) for females. It was an instrumental study where the Spanish Experimental Version of Stat-Trait Depression (ST/DEP) was used. All participants received information about research and they answered the questionnaires voluntarily. The findings are shown separately for the two scales (State and Trait) and for the two sub-scales (Dysthymia and Euthymia). Data indicated significant differences between males and females, being the highest scores for females. This is an evidence related to the higher prevalence of depression in women. It is very important to remark that essentially the same strong state and trait factors were found for both males and females, according to the factor structure of the Spanish Experimental Version of the State-Trait Depression Questionnaire (ST/DEP). These factors explained the 54% variance for females and of 53% for males. The Promax Rotation differentiated two factors clearly: Dysthimia and Euthymia. That was similar to what was found in the original English form of the ST-DEP. The factorial structure was then confirmed, because of the bifactorial structure which differentiated the negative and positive affectivity of Depression. Another positive result was the test ability to detect slight changes on affectivity, which will be useful to differentiate between clinical and non clinical population. It is important to point out that the ST/DEP is a measurement of one component of depression: affectivity, which has been identified as a relevant component in this disorder, but this tool is not enough to diagnose depression. This fact is relevant, because some tools for depression assessment are used as a diagnostic criteria, a fact that increases confusion in making a differential diagnostic between anxiety and depression or some other symptoms and clinical problems. All this results provide evidences of the psychometric properties of the Spanish ST-DEP, and make this scale a fruitful and useful assessment instrument.

Effects of anxiety on communication tasks for children in traditional and individualized-multiage classrooms.

The effects of anxiety on concept acquisition were evaluated for first and second grade children enrolled in either a traditional or in an individualized or multiage learning program, the latter specifically designed to reduce anxiety during the learning process. Regardless of their learning environment, first graders who scored high on trait anxiety, measured by the State-Trait Anxiety Inventory for Children, performed more poorly than those with low trait anxiety. Individualized-multiage second grade children scored lower on state anxiety than children in the traditional group. The largest reduction in anxiety occurred at the second grade, suggesting that anxiety reduction was cumulative for the individualized-multiage program children during the first two years of their primary grade education. However, the individualized-multiage environment was detrimental to performance of second graders on the easier concrete concept acquisition test, suggesting that some anxiety is needed during learning to enhance attention and facilitate performance.

Evaluating performance of law enforcement personnel during a stressful training scenario.

Police trainees who were ready to graduate from the Federal Law Enforcement Training Center (FLETC) volunteered to participate in an exercise designed to evaluate their survivability. In a highly stressful interactive scenario, which included a hostage situation, performance was evaluated for a range of responses, including: shooting judgment and accuracy, communications, and coping with a weapon malfunction. Nineteen percent of subjects shot the hostage, a failure rate that falls in the reported range of friendly fire casualties in military combat. The Spielberger Trait Anger Scale showed an association with shot placement and performance during the gunfight as well as with overall performance scores.

Measuring epistemic curiosity and its diversive and specific components.

A questionnaire constructed to assess epistemic curiosity (EC) and perceptual curiosity (PC) curiosity was administered to 739 undergraduates (546 women, 193 men) ranging in age from 18 to 65. The study participants also responded to the trait anxiety, anger, depression, and curiosity scales of the State-Trait Personality Inventory (STPI; Spielberger et al., 1979) and selected subscales of the Sensation Seeking (SSS; Zuckerman, Kolin, Price, & Zoob, 1964) and Novelty Experiencing (NES; Pearson, 1970) scales. Factor analyses of the curiosity items with oblique rotation identified EC and PC factors with clear simple structure. Subsequent analyses of the EC items provided the basis for developing an EC scale, with Diversive and Specific Curiosity subscales. Moderately high correlations of the EC scale and subscales with other measures of curiosity provided strong evidence of convergent validity. Divergent validity was demonstrated by minimal correlations with trait anxiety and the sensation-seeking measures, and essentially zero correlations with the STPI trait anger and depression scales. Male participants had significantly higher scores on the EC scale and the NES External Cognition subscale (effect sizes of r =.16 and.21, respectively), indicating that they were more interested than female participants in solving problems and discovering how things work. Male participants also scored significantly higher than female participants on the SSS Thrill-and-Adventure and NES External Sensation subscales (r =.14 and.22, respectively), suggesting that they were more likely to engage in sensation-seeking activities.

Creating healthier workplaces: The American Psychological Association/National Institute of Occupational Safety and Health cooperative agreement. Introduction and historical overview.

This article introduces the special section on the American Psychological Association/National Institute for Occupational Safety and Health (APA/NIOSH) collaboration. The section includes an overview statement of National Institute for Occupational Safety and Health research by Linda Rosenstock and 5 competitively peer-reviewed articles submitted to the Journal of Occupational Health Psychology following their presentation in an earlier form at the 3rd APA/NIOSH conference in September 1995. This article provides a brief history of the APA/NIOSH collaboration forged at the turn of this decade.

Self-report of chest pain symptoms and coronary artery disease in patients undergoing angiography.

The relation of self-reported chest discomfort to the presence of atherosclerosis was examined, taking age and gender differences into account. Sixteen practicing cardiologists independently rated the items of a self-report questionnaire of angina pectoris (AP) symptoms according to their adjudged likelihood of being associated with coronary artery disease (CAD). Inpatients' (130 male and 82 female) responses to this questionnaire were obtained on the day prior to coronary angiography and scored according to their reporting of 12 symptoms endorsed by all 16 cardiologists, 25 symptoms endorsed by at least 90% of the cardiologists, and responses to items used in the Rose questionnaire, a brief survey tool for diagnosis of chest pain. Finally, patients' angiographic results were rated for presence of 75% or more CAD of one or more coronary arteries. Surprisingly, more symptoms were reported by patients without significant CAD, regardless of age or gender.