State and trait anxiety revisited.

State and trait anxiety theory and assessment are reviewed. The person (trait anxiety) and the situation are important in determining levels of state anxiety. The facet of trait anxiety and the stressful situation must be congruent in order to evoke increases in state anxiety. The multidimensional interaction model is reviewed and empirical research is presented. A discussion of anxiety viewed in a dimensional versus a categorical conceptualization is presented. Misconceptions regarding the multidimensionality of trait anxiety are discussed. Finally, it is concluded that anxiety should be viewed as a dimensional construct and that the multidimensionality of state and trait anxiety should be considered in both theory and assessment.

Coping, control, and adjustment in Type 2 diabetes.

The relationships of both coping strategies and perceived control to psychological and physiological adjustment were investigated in 115 adults (65 women, 50 men) with Type 2 diabetes. Results showed that (a) emotional preoccupation and palliative coping were positively correlated with depression and state anxiety, whereas perceived control was negatively correlated with depression, state anxiety, and hemoglobin A1c (HbA1c); (b) instrumental coping predicted lower depression; (c) perceived control moderated the relationships between instrumental coping and depression, and emotional preoccupation coping and HbA1c; and (d) emotional preoccupation coping mediated the relationships between perceived control and depression, and perceived control and state anxiety. Results are discussed in terms of the goodness-of-fit hypothesis (V. J. Conway & D. J. Terry, 1992), optimal coping, and the importance of perceived control in psychological and physiological adjustment.

The interaction model of anxiety and the threat of Quebec's separation from Canada.

The interaction model of anxiety was investigated by assessing trait and state anxiety in students at a Canadian university during the Quebec referendum. The results of Study 1 confirmed that the threat of separation by Quebec from Canada was perceived as an ambiguous, uncertain situation. In Study 2, reactions to this situation were assessed by having participants complete measures of anxiety and situation perception at Time 1 (i.e., 3 hr before the event) and Time 2 (i.e., 1 week after the vote). The results provide support for the interaction model; individuals who were high in trait anxiety in ambiguous situations and appraised the referendum situation as threatening were characterized by elevated state anxiety before the uncertain outcome of the vote. The results illustrate the need to examine trait anxiety and specific appraisals of situational threat in uncertain life situations.

Beck depression inventory: exploring its dimensionality in a nonclinical population.

The Beck Depression Inventory (BDI) was factor analyzed to examine its potential multidimensionality. Results indicate that the items on the BDI assess two primary dimensions of depression: cognitive-affective and physiological symptoms. Reliabilities for the items comprising each of the factors were acceptable. Between-groups analyses showed that women scored significantly higher than men on both of the factors and on total depression. Within-group analyses showed that levels of cognitive-affective and physiological depression did not differ significantly within the total sample, or for men or women. In future revisions of the BDI, it may be useful to develop scoring systems based on these two dimensions, both to differentiate between types and levels of depression, and to consider implications for prognosis and treatment response.

Personality psychology: research trends for 1993-1995.

Articles published in five prominent personality journals for the three-year period 1993-1995 were reviewed in order to identify recent trends in personality research. Each article was assessed in terms of research methodology and content area. Research methodology has changed very little, the exceptions being a shift away from laboratory settings and a greater use of nonuniversity participants. Results for content demonstrate that over time certain topics emerge and fade from popularity. Current popular topics include traits, emotion/motivation, and health psychology. The general lack of advancement in methodology is discussed, and the current "hot topics" in content area are compared with those of the past. In addition, some comparisons are made between current personality research in North America versus research in Europe.

Examining the evidence for anxiety-related cognitive biases in obsessive-compulsive disorder.

In light of current concerns about the diagnostic classification of obsessive-compulsive disorder (OCD), this article critically examines recent experimental research on anxiety-related cognitive biases in OCD in order to determine whether it provides grounds for OCD's differentiation from other anxiety disorders. This small body of work is found to be fraught with defects, anomalies, and inconsistencies. These findings contrast dramatically with the robust results obtained with other clinical anxiety disorders. When biases are in evidence it tends to be with a select group of subjects, that is, those with contamination concerns. It is suggested that only this subtype of OCD, or some core characteristic underlying it, may be associated with cognitive tendencies comparable to those found in other anxiety disorders (i.e., biases at the attentional level associated with the emotional tone, or content, of information). Cognitive tendencies in other subtypes likely require different explanatory frameworks. This review provides evidence for the partial uniqueness of OCD from other anxiety disorders.

Predicting cardiac patients' quality of life from the characteristics of their spouses.

Recovery from surgery can be facilitated by personal and social resources such as perceived self-efficacy and social support. Moreover, the existence of a social network and the behavior of its members can also have a positive effect. Patients (N = 381; 302 men, 79 women) undergoing heart surgery were surveyed once before and twice after surgery. In addition, 114 social-network members (18 men, 96 women), most of them spouses, reported about their own perceived resources at Time 1. The patient-spouse dyad was chosen as the unit of analysis. It turned out that characteristics of spouses were related to those of patients. Recovery from surgery at Time 2 and readjustment to normal life after half a year (Time 3) could be partly predicted by spouses' perceived self-efficacy and social support as measured at Time 1.

Models of job-related stress and personal achievement among consultant doctors.

The antecedents and outcomes of feelings of job-related stress and personal achievement were studied in a large sample of consultant doctors working in Scotland. In a sample of 333 doctors it was found that a tendency to use emotion-oriented coping strategies and negative appraisals of organizational changes in the practice of medicine mediated the effect of the personality dimension of Neuroticism on reported job stress. Job stress levels predicted the degree of 'burnout' experienced by doctors, i.e. their tendencies to be emotionally exhausted by their work and to dehumanize patients. Higher clinical workloads were related to higher levels of stress but also to higher feelings of personal achievement. A substantial proportion of the variance in many of the variables in the stress model was accounted for by a general tendency to experience negative emotions, closely related to Neuroticism; this general factor appeared to be similar to the recently formulated concepts of 'negative affectivity' and 'somatopsychic distress'. The personality factors of Extraversion and Conscientiousness both contributed to positive feelings of personal achievement (N = 344); the effect of Extraversion was direct, whereas the effect of Conscientiousness was mediated by a tendency to use task-oriented coping strategies. Models of the processes of stress and personal achievement were tested for acceptability using the EQS Structural Equations Program. The implications of the models for transactional theories of stress are discussed.

Anxiety sensitivity and panic attack symptomatology.

The relationship between 23 specific panic attack symptoms and the 16 items of the Anxiety Sensitivity Index was investigated using a factor analytic procedure with a large sample (N = 209) of panic disorder patients. A five-factor model resulted in three panic symptom clusters (cardio-respiratory, dizziness-related, and cognitive symptoms) and two anxiety sensitivity factors (fear of physical symptoms and fear of psychological symptoms). The five-factor model accounted for 50% of the variance. There was some overlap between anxiety sensitivity and panic symptomatology and the cognitive panic symptom "fear of dying" loaded strongly on the anxiety sensitivity fear of physical sensations factor rather than on any of the panic symptoms factors. These results demonstrate that anxiety sensitivity can be independent of panic and are also consistent with a cognitive view of panic in which catastrophic cognitions that occur during a panic attack are more associated with a cognitive style or personality trait than with the severity of physical symptoms.

An examination of levels of agoraphobic severity in panic disorder.

Based on the results of previous studies, several factors believed to be related to the development of agoraphobia were simultaneously assessed in 195 panic disorder patients (57 males, 138 females) with various levels of DSM-III-R-defined agoraphobia: none, mild, moderate, or severe. The four groups of patients significantly differed from each other on self-reports of phobic avoidance, although all the groups reported a similar type of panic attack. The four groups also did not significantly differ on catastrophic panic cognitions (e.g. fear of dying), fear of anxiety symptoms (anxiety sensitivity), or variables related to spontaneous panic. Neither severity or frequency of panic was predictive of severity of agoraphobia. The anticipation of panic only in relation to agoraphobic situations was predictive of severity of agoraphobia, followed by perceived lifestyle restrictions due to panic, and trait anxiety regarding ambiguous or novel situations. Regardless of level of agoraphobia, patients tended to avoid situations where they anticipated panic would occur, indicating that panic and agoraphobia do not share a unique or exclusive relationship. Panic disorder with various levels of phobic avoidance, rather than just agoraphobia, would appear to be a more valid diagnostic category.

The symptom structure of panic attacks.

Panic attack symptomatology was investigated in 212 panic disorder patients (60 men, 152 women) using the Panic Attack Questionnaire, Feelings of helplessness and thoughts of escape had the highest mean severity ratings, but are not currently listed in the DSM-III-R. The DSM-III-R symptoms labeled choking or smothering sensations, paresthesias, nausea, and chest pain had low severity ratings. Evidence was obtained for a three-factor model of panic symptomatology consisting of dizziness-related symptoms, cardiorespiratory distress, and cognitive factors. These results provide only limited support for the current DSM-III-R symptom structure, and support the notion that panic disorder is a heterogeneous condition.

Levels of "nonclinical panic".

Many individuals experience DSM-III-R-defined panic attacks but do not seek treatment--"nonclinical panic". However, there is a substantial range in the frequency of panic attacks reported by these individuals. The present study compared 35 frequent panickers (panic in a 3-week period), 50 infrequent panickers (panic in the past year only), and 267 nonpanickers (no lifetime history of panic) on several measures of psychopathology and panic attack characteristics. Only the frequent panickers had significantly elevated levels of self-reported psychopathology and phobic avoidance compared to nonpanickers, and the three groups of subjects differed significantly on anxiety sensitivity scores. Frequent and infrequent panickers reported similar panic attack characteristics. Overall, the results strongly suggest that only frequent panickers exemplify the anxiety state referred to as "nonclinical panic."

A factor analytic study of coping styles and the MMPI-2 content scales.

The relationships among coping styles and psychopathology were examined with the MMPI-2 content scales and a reliable and valid coping measure--the Coping Inventory For Stressful Situations (CISS). Subjects were 167 higher-functioning normal adult males. The results are consistent with previous research that employed the CISS; a strong positive association was found between emotion-oriented coping strategies and various measures of psychopathology. Task-oriented coping strategies were found to be unrelated to these measures. Results are discussed in the context of a potential model for understanding the various relationships among coping styles and psychopathology.

Self-reports of depression and state-trait anxiety: evidence for differential assessment.

Several researchers have found anxiety and depression to be indistinguishable in nonclinical samples and have suggested that both constructs may be components of a general psychological distress process. Another possibility is that overlap is due to the psychometric limitations of scales used. A series of exploratory factor analyses were conducted in a nonclinical sample (N = 605) using the Beck Depression Inventory (BDI; Beck, 1978), the State-Trait Anxiety Inventory (STAI; Spielberger, 1983), and the Endler Multidimensional Anxiety Scales (EMAS; Endler, Edwards, & Vitelli, 1991). Both state and trait anxiety and depression could be differentiated with the BDI and the EMAS but not with the STAI. Some theoretical models of negative affectivity or general psychopathology may be premature.

A meta-analysis of treatments for panic disorder with agoraphobia: imipramine, alprazolam, and in vivo exposure.

The most common pharmacological treatments for panic disorder with agoraphobia (PDA) include the use of imipramine and alprazolam while the most common behavior therapy is the use of graded in vivo exposure. Several studies have found these treatments to be superior to placebo in the treatment of PDA, but it has not been clear if there are differences among these three treatments. It has also not been clear for what aspects of PDA each treatment is the most effective. The purpose of this study was to conduct a meta-analysis of the results of relevant treatment outcome studies on a number of dependent variables (e.g., panic attack severity, dysphoria, avoidance behavior). Few studies satisfied the minimum criteria for inclusion and the final data pool consisted of 34 treatment studies. Imipramine was found to be generally ineffective for most variables. Alprazolam was significantly effective for panic and anxiety variables in PDA, while exposure was significantly effective for phobia variables. Exposure had the most consistently strong effect sizes.

Situations and specific coping strategies associated with clinical and nonclinical panic attacks.

The present paper reports the results of further comparisons between clinical and nonclinical panickers. Both panic disorder patients and nonclinical panickers reported a variety of situational contexts associated with panic attacks, and differed markedly in their attempts to cope with panic. Nonclinical panickers tended to use more 'positive' coping strategies in response to panic. Conversely, one of the most commonly used and subjectively effective coping strategies reported by panic disorder patients was to escape the situation.

Multidimensionality of state and trait anxiety: factor structure of the Endler Multidimensional Anxiety Scales.

The Endler Multidimensional Anxiety Scales (EMAS) are derived from an interactional model of personality that proposes that anxiety is a function of the interaction of person and situation variables. The EMAS distinguish between state and trait anxiety and assume that both are multidimensional constructs. The EMAS were administered to 2,009 students in a neutral situation. Three factor analyses were performed to clarify the empirical relation between state and trait anxiety and the variables within the 2 domains. Results support the distinction between state and trait anxiety. Factor analysis of the state items provided support for the separate dimensions of cognitive and autonomic state anxiety. Factor analysis of the trait items provided support for trait anxiety multidimensionality. Four congruent factors were associated with increases in state anxiety in 4 general situations: Social Evaluation, Physical Danger, Ambiguous, and Daily Routines.

A review of the psychopharmacology of panic disorder: individual differences and non specific factors.

This paper critically examines the pharmacological provocation and treatment of panic disorder. An analysis of research findings on how panic attacks are induced indicates that there are psychological and non specific factors that may mediate biochemical etiological models, and these individual differences need to be investigated further. This has important implications for the psychopharmacological management of panic. A review of studies on treating panic disorder with imipramine and alprazolam emphasizes the importance of several non specific factors that include the role of self-directed in vivo exposure and changes in dysphoria and self-efficacy (subjective beliefs regarding personal competency) in predicting outcome. It is recommended that any treatment of panic-related disorders include self-directed, in vivo exposure.

Anxiety sensitivity and nonclinical panic attacks.

The present study examined anxiety sensitivity in relation to trait anxiety and the occurrence of nonclinical panic attacks in 265 subjects. Fifty percent of high anxiety sensitivity subjects reported panic attacks (both cued and spontaneous) in the past year. In addition, almost 42% of subjects with high anxiety sensitivity but no history of panic reported a high level of trait anxiety concerning physical danger. The results suggest that anxiety sensitivity is frequently not independent of other forms of anxiety.