Disgust sensitivity mediates the effects of race on contamination aversion.

African Americans report greater contamination aversion than European Americans. Few studies have attempted to identify potential causes for this elevated contamination aversion, though existing research and theory suggests this may be partly due to concomitant heightened disgust sensitivity. The present study examined the relations between race, disgust sensitivity, and contamination aversion among African and European Americans. A convenience sample of fourhundred and twenty-nine participants completed the Disgust Scale - Revised (DS-R) and the Padua Inventory - Revised (PI-R). African Americans endorsed greater disgust sensitivity (DS-R total) - particularly on the core and contamination subscales of the DS-R - and scored higher on the contamination subscale of the PI-R (but not on other subscales) than European Americans. Mediational analyses revealed a significant total effect of race on contamination aversion and a significant indirect effect of race on contamination aversion through disgust sensitivity; the direct effect of race on contamination aversion remained significant even after controlling for race. These findings suggest that elevated contamination aversions among African Americans may be partly due to elevated disgust sensitivity. If confirmed with larger and clinical samples, and more robust experimental methods, this relationship may prove to have implications for the treatment of contamination-based obsessive-compulsive disorder (OCD) among African Americans.

Specific and differential prediction of health anxiety by disgust sensitivity and propensity.

Current models of health anxiety suggest that fear resulting from false alarms to perceived threats to one's health results in the development of hypochondriasis and related disorders. Disgust has been proposed as an affective response that may function as an etiological and maintenance mechanism in health anxiety. Moreover, the way in which an individual perceives the disgust response (disgust sensitivity) may affect health anxiety, separately from their likelihood of experiencing disgust (disgust propensity). The present study utilized multiple hierarchical regression analysis to investigate the degree to which self-reported disgust sensitivity and disgust propensity differentially predict elevated health anxiety in a sample of 620 non-treatment-seeking undergraduates. Further, this effect is tested in comparison to that of anxiety sensitivity, a construct demonstrated to be strongly related to health anxiety. Analyses indicate that disgust sensitivity, rather than disgust propensity, is primarily responsible for this relation. An additional analysis tested the specificity of disgust sensitivity relative to anxiety sensitivity. Disgust sensitivity was no longer significant after including anxiety sensitivity in the model. Suggestions for further evaluation of this relation are provided. These results suggest that although disgust sensitivity may appear related to health anxiety, this relation may be confounded by anxiety sensitivity.

A behavioral test of contamination fear in excessive health anxiety.

BACKGROUND AND OBJECTIVES: Health anxiety is characterized by a preoccupation with the possibility of having a serious health condition or disease. Contemporary conceptualizations of health anxiety have improved in recent years to incorporate a fear of acquiring an illness; however, there is limited experimental data demonstrating the presence of fear of contamination among health anxious individuals. METHOD: The present study utilized behavior approach tasks (BATs) to examine the degree to which contamination fear is present in elevated health anxiety. Participants were 60 undergraduate students who reported elevated health anxiety, contamination fear, or no anxiety about either health or contamination. Participants completed four BATS from which avoidance, anxiety, and disgust ratings were derived. RESULTS: Health anxious and contamination fearful individuals exhibited a similar degree of avoidance during the BATs. Contamination fearful participants reported significantly more anxiety and disgust relative to the non-anxious controls, but not the health anxious participants. Health anxious participants did not report more anxiety or disgust than the non-anxious participants. LIMITATIONS: The use of an analogue sample may limit the extension of these findings to clinical populations. Additionally, the role of general negative affect could not be reliably determined in the absence of an anxious control group. CONCLUSIONS: These findings suggest that contamination fear may be a source of conceptual overlap between health anxiety and other disorders characterized by contamination fear. This highlights the importance of considering contamination fear in excessive health anxiety.

Anxiety and its treatment: promoting science-based practice.

In this article we analyze ways that psychological science can inform the treatment of anxiety disorders. We focus on experimental psychopathology research to describe the structure of anxiety and the functions of danger, safety, predictability and controllability in contributing to disorder. We then address science-based practice in terms of principles of change and the benefits from the self-corrective nature of science, contrasting this form of practice with treatments that are not grounded in basic learning theory. Models for dissemination and implementation of science-based practices are described and related to practitioner attitudes regarding scientific evidence. Finally, we consider practice implications when treatments are, and are not, based on the informative role of clinical psychological science.

Development and initial validation of the medical fear survey-short version.

The present investigation employs item response theory (IRT) to develop an abbreviated medical fear survey (MFS). Application of IRT analyses in study 1 (n = 931) to the original 50-item MFS resulted in a 25-item shortened version. Examination of the location parameters also resulted in a reduction of the Likert-type scaling of the MFS by removing the last response category ("terror"). The five subscales of the original MFS were highly correlated with those of the MFS-short version. The short version also displayed comparable convergent and discriminant validity with the original MFS in relation to measures of fear, disgust, and anxiety. Confirmatory factor analysis in Study 2 revealed that the five-factor structure of the MFS-short form fit the data well in U.S. (n = 283) and Dutch (n = 258) samples. The short form also had comparable convergent and discriminant validity with the original MFS in relation to domains of disgust in both samples. Receiver operating characteristic (ROC) analysis in Study 3 demonstrated that the subscales of the short version were comparable with the original MFS in classifying participants high (n = 40) and low (n = 40) in blood/injection phobia. Last, structural equation modeling in Study 4 (n = 113) revealed that the MFS-short form demonstrated excellent convergent/discriminant validity with strong associations with injection fear and no association with spider fear. These findings suggest that the MFS-short form has considerable strengths, including decreased assessment time, while retaining sound psychometric properties.

Secondary trauma symptoms in clinicians: a critical review of the construct, specificity, and implications for trauma-focused treatment.

Advocates of the concept of secondary traumatization propose that clinicians who provide trauma-focused treatment may be particularly at risk for experiencing secondary trauma symptoms. This specific symptom presentation purportedly develops following exposure to the traumatic experiences described by their clients. Consequently, these professionals have advocated for increases in resources devoted to the prevention and treatment of secondary trauma symptoms (e.g., enhanced clinician training, increase in availability of treatment options for affected trauma workers, etc.). A review of empirical literature examining prevalence and specificity of secondary trauma symptoms in trauma clinicians is provided. Findings are mixed and often indicate that trauma clinicians are not frequently experiencing "clinically significant" levels of symptoms and that these symptoms may not be uniquely associated with trauma-focused treatment. Finally, it is argued that additional clarification and research on the criterion, course, and associated impairment are needed. Recommendations for future research are provided.

Unique affective and cognitive processes in contamination appraisals: Implications for contamination fear.

A large body of evidence suggests an important role of disgust in contamination fear (CF). A separate line of research implicates various cognitive mechanisms in contamination fear, including obsessive beliefs, memory biases, and delayed attentional disengagement from threat. This study is an initial attempt to integrate these two lines of research and examines whether disgust and delayed attention disengagement from threat explain unique or overlapping processes within CF. Non-clinical undergraduate students (N = 108) completed a spatial cueing task, which provided measures of delayed disengagement from frightening and disgusting cues, and a self-report measure of disgust propensity (DP). Participants also completed a chain of contagion task, in which they provided contamination appraisals of an object as a function of degrees of removal from an initial contaminant. Results demonstrated that DP predicted greater initial contamination appraisals, but a sharper decline in estimations across further degrees of removal from the contaminant. Delayed disengagement from disgust cues uniquely predicted sustained elevations in contamination estimations across further degrees of removal from the contaminant. These results suggest that DP and delayed disengagement from disgust cues explain unique and complimentary processes in contamination appraisals, which suggests the utility of incorporating the disparate affective and cognitive lines of research on CF.

Disgust and Obsessive Beliefs in Contamination-related OCD.

A large body of evidence suggests that disgust is an important affective process underlying contamination fear. An independent line of research demonstrates that obsessive beliefs, particularly overestimations of threat, are also an important cognitive process underlying contamination fear. The present study attempts to integrate these two lines of research by testing whether obsessive beliefs potentiate the influence of disgust propensity on contamination fear. The interaction between disgust propensity and obsessive beliefs was tested in two large non-clinical samples (N = 252 in Study 1; N = 308 in Study 2) using two different self-report measures of contamination fear. Regression analyses supported the hypotheses in both samples. The interaction remained significant when controlling for negative affect. The results are hypothesized to suggest that contamination fear results, at least partly, from obsessive beliefs about the contamination-based appraisals that accompany heightened disgust responding. These results complement previous affective-driven explanations of the role of disgust in contamination fear by suggesting cognitive factors that similarly potentiate disgust's role in contamination fear.

Disgust in contamination-based obsessive-compulsive disorder: a review and model.

Obsessive-compulsive disorder (OCD) is characterized by the presence of unwanted, intrusive thoughts coupled with ritualized behaviors intended to reduce subjective anxiety. Although once considered a homogeneous disorder, recent findings support a view of OCD as consisting of symptom subtypes. Additionally, there has been increased interest in the contribution of disgust to various forms of psychopathology. The present article summarizes the available literature on contamination-based OCD with an emphasis on the role of disgust as it pertains to the etiology and maintenance of this form of OCD. We propose an updated model of contamination-based OCD that accounts for the elevated disgust response observed in individuals with this form of OCD. Treatment implications of a disgust-based model of the disorder are discussed in the context of cognitive-behavioral therapy.

Attributional style and anxiety sensitivity as maintenance factors of posttraumatic stress symptoms: A prospective examination of a diathesis-stress model.

Diathesis-stress models of posttraumatic stress disorder (PTSD) assert that traumatic events function as stressors that interact with vulnerabilities to influence the development of PTSD. The present study prospectively examined negative attributional style (NAS) and anxiety sensitivity (AS) as maintenance factors for PTSD in female adult sexual assault victims. A diathesis-stress model was tested by examining interactions between the vulnerabilities and negative life events. The present study included both the traditional three-factor model of PTSD (re-experiencing, avoidance and emotional numbing, and arousal) and the dysphoria four-factor model of PTSD (re-experiencing, avoidance, arousal, and dysphoria). Robust regression analyses revealed that negative life events at Time 2 significantly predicted increases in all clusters of the three-factor model (i.e., re-experiencing, avoidance and numbing, and arousal) and the re-experiencing, arousal, and dysphoria clusters of the four-factor model (but not avoidance). Neither NAS nor AS significantly independently predicted any of the symptom clusters for either model. Both NAS and AS interacted with negative life events to predict increases in the avoidance and numbing symptoms. However, examination of the dysphoria four-factor model of PTSD revealed that the NAS and AS interactions with negative life events only predicted dysphoria symptoms.

Disgust, fear, and the anxiety disorders: a critical review.

Anxiety disorders have traditionally been conceptualized as reflecting the emotions of fear and anxiety. A developing program of research demonstrates a relation between disgust and three specific anxiety disorders: blood-injection-injury (BII) phobia, spider phobia, and contamination-related obsessive-compulsive disorder (OCD). This review serves three purposes. First, the authors review the response patterns predicted to be observed if the emotional response in these disorders involved disgust versus fear. The review suggests specific response patterns that characterize disgust and fear in the domains of heart rate, facial expression, neural activity, and cognitive processes. Second, the authors review extant research employing measures of these domains in spider phobia, BII phobia, and contamination-related OCD. The evidence suggests that both fear and disgust characterize each of these disorders, but the magnitude at which the emotions characterize the disorders may depend on the response domain measured. For example, disgust may be more involved in spider phobia in appraisals and facial expression, but less involved in neural correlates or heart rate domains. Third, the authors suggest guidelines for future research, including concurrent use of specific measures as well as examining whether the different emotions in different response domains respond to similar interventions (e.g., exposure).

Differential habituation of fear and disgust during repeated exposure to threat-relevant stimuli in contamination-based OCD: an analogue study.

In the present study, participants (N=20) displaying marked contamination concerns were provided 30 min of repeated in vivo exposure to threat-relevant stimuli (cleaning a 'dirty' bed pan), during which time their fear and disgust levels were repeatedly assessed. Results indicated that repeated exposure led to a significant decline in fear but not disgust. The observed decline in fear remained significant after accounting for changes in disgust and vice versa. Although initial disgust was higher than initial fear ratings, differences between the two slopes were not statistically significant. Baseline trait anxiety and global disgust sensitivity levels prior to exposure did not moderate the level of fear or disgust activation during exposure. However, sensitivity specifically related to core and contamination disgust was marginally associated with fear and disgust parameters during outcome. There was also evidence that less fear decline during repeated exposure was associated with higher disgust ratings after the exposure was completed. Theoretical and clinical implications of the present findings for the treatment of contamination concerns in obsessive-compulsive disorder are discussed.

Evaluative conditioning of fear and disgust in blood-injection-injury phobia: specificity and impact of individual differences in disgust sensitivity.

The present study examines whether the repeated pairing of neutral facial expressions with phobic-relevant stimuli differentially influences evaluative ratings of fear and disgust between analogue blood-injection-injury (BII) phobic (n=40) and non-phobic (n=40) participants. Consistent with prior research, BII phobics reported greater disgust sensitivity than non-phobic participants even after controlling for between group differences in anxiety symptoms. Results from the evaluative conditioning experiment indicated that pre- to posttest increases in fear ratings were only marginally greater for phobic compared to non-phobic participants. However, increases in disgust from pre- to posttest were greater for phobic compared to non-phobic participants and greater for neutral expressions that were paired with threat-relevant stimuli compared to stimuli not paired with threat-relevant stimuli. Subsequent analysis also indicated that pre- to posttest increases in disgust ratings of neutral expressions that were paired with threat-relevant stimuli was moderated by disgust sensitivity levels among phobic and non-phobic participants. Heightened fear and disgust ratings were subsequently reduced by an extinction procedure. Implications of present findings in understanding the role of fear and disgust in BII phobia are discussed.

Information processing in contamination fear: a covariation bias examination of fear and disgust.

The current study represents the first examination of covariation biases in contamination fear. Using an undergraduate sample we examined covariation bias for specific emotion outcomes (fear specific and disgust specific) associated with contamination stimuli in high contamination fear (HCF; n=32) and low contamination fear (LCF; n=30) individuals. Following random stimulus-outcome presentation participants provided estimations on the proportion of each presented stimulus-expression pairing. Analyses revealed a specific bias for the over-estimation of fear and disgust contingencies among the HCF group, but not the LCF group. The current study also revealed a specific covariation bias among HCF, not LCF, participants to over-estimate the contingency between contamination stimuli and fear outcomes, not disgust outcomes. Further, results indicate that HCF individuals significantly under-estimate the covariation among contamination stimuli and safety outcomes compared to LCF participants. These findings are discussed in terms of theoretical implications for information processing biases in anxiety disorders.

Disgust sensitivity and emotion regulation potentiate the effect of disgust propensity on spider fear, blood-injection-injury fear, and contamination fear.

Research consistently reveals a relation between disgust and specific anxiety concerns, but research has only begun to investigate possible mechanisms by which this relation occurs. The current study tested whether disgust sensitivity (DS; a specific difficulty regulating disgust) and general emotion dysregulation (GED; non-emotion-specific regulation difficulties) moderated the relation between disgust propensity (DP) and spider fear, blood-injection-injury (BII) fear, and contamination fear. A total of 594 undergraduate students completed verbal-report measures of DP, DS, GED, negative affectivity, and spider, BII, and contamination fears. Results suggest that GED potentiates the ability of DP to predict spider and contamination fears, but not BII fears. DS potentiates the ability of DP to predict BII fears, but not spider or contamination fears. These data suggest that GED and DS are possible mechanisms that strengthen the influence of DP on spider, BII, and contamination fears. The present study demonstrates the utility of incorporating emotion regulation into the theory of disgust in certain anxiety disorders.

Attentional Bias Differences between Fear and Disgust: Implications for the Role of Disgust in Disgust-Related Anxiety Disorders.

Research demonstrates a relation between disgust and anxiety-related pathology; however, research has yet to reveal mechanisms by which disgust may contribute to anxiety. The current experiment examined attentional bias characteristics as one route by which disgust influences anxiety. Eighty undergraduate participants completed a rapid serial visual presentation attention task using fear, disgust, or neutral target stimuli. Task-relevance of the target's presentation was also manipulated. Results revealed that task-relevant disgust targets impaired attention among all participants, but task-irrelevant disgust targets impaired attention only in high disgust prone individuals. Difficulty in disengagement characterized both disgust and fear attentional biases, but the difficulty in disengagement was greater for disgust compared to fear attentional biases. High disgust prone individuals displayed exaggerated difficulty in disengaging attention from disgust targets compared to low disgust prone individuals. The results suggest that disgust attentional biases differ from fear attentional biases. The characteristics of disgust attentional biases are discussed as possible mechanisms by which disgust functions in certain anxiety disorders.

Information processing biases in spider phobia: application of the Stroop and "White Noise" Paradigm.

The present study examines attentional and implicit memory biases in spider phobic and nonphobic participants. The results showed that spider phobics demonstrated increased interference for neutral, negative, and spider-relevant words on a computerized Stroop task. However, no group differences emerged when adjusting for differences in color-naming speed. Prior exposure to a dead spider did result in higher overall Stroop interference in spider phobics and this appeared to be mostly pronounced for spider-relevant words. Implicit memory bias for threat was examined with a noise judgment task. Participants first heard neutral and spider-relevant sentences and implicit memory for these sentences was evaluated by having participants rate the volume of noise accompanying the presentation of old sentences intermixed with new sentences. An implicit memory bias is indicated if participants rate noise accompanying old sentences as less loud than noise accompanying new sentences. No evidence was found for an implicit memory bias in spider phobics. These findings are discussed in relation to the role of information processing biases in spider phobia.

Specificity of emotional maintenance processes among contamination fears and blood-injection-injury fears.

Research evidence consistently demonstrates a relation between disgust and anxiety-related pathology. Despite ample evidence implicating a functional role of disgust in anxiety, limited research has focused on the process by which disgust influences anxiety. Recent evidence indicates that fear of responding with disgust predicts contamination fears, thus elucidating a process by which disgust contributes to contamination fears. In the current study, we tested whether fear of responding with disgust is specific to contamination fears or generalizes to blood-injection-injury (BII) fears. Undergraduate psychology students (N=259) completed measures of anxiety sensitivity (AS), trait anxiety, disgust, contamination fears, and BII fears. Data analysis revealed main effects of both AS and disgust in predicting both contamination and BII fears. The interaction between AS and disgust (i.e., being fearful of responding with disgust), however, predicted only contamination fears and not BII fears. The results suggest that fear of responding with disgust is a unique maintenance process specific to contamination fears. Theoretical and clinical implications for both contamination and BII fears are discussed.

Structural differentiation of disgust from trait anxiety in the prediction of specific anxiety disorder symptoms.

Research has begun to implicate the role of disgust in the etiology of specific phobias and obsessive-compulsive disorder (OCD). However, it remains unclear if the association between disgust and specific anxiety disorder symptoms is an artifact of trait anxiety or a potential mechanism through which trait anxiety effects specific anxiety disorder symptoms. The present study employed structural equation modeling to differentiate disgust from trait anxiety in the prediction of four types of specific anxiety disorder symptoms in a non-clinical sample (N=352). Results indicate that disgust and trait anxiety latent factors were independently related to spider fears, blood-injection-injury (BII) fears, general OCD symptoms, and OCD washing concerns. However, when both variables were simultaneously modeled as predictors, latent disgust remained significantly associated with the anxiety disorder symptoms, whereas the association between latent trait anxiety and the anxiety disorder symptoms became non-significant or was substantially reduced. Statistical tests of intervening variable effects converged in support of disgust as a significant intervening variable between trait anxiety and spider fears, BII fears, and OCD symptoms (particularly washing concerns). The relevance of these findings for future research investigating the role of disgust in specific anxiety disorders is discussed.