Anxiety Disorders: Craske MG

Craske MG, Kircanski K, Zelikowsky M, Mystkowski J, Chowdhury N, Baker A. · Department of Psychology, Los Angeles, CA 90095-1563, USA. · Behav Res Ther. · Pubmed #18005936 No free full text.

Abstract: Prevailing models of exposure therapy for phobias and anxiety disorders construe level of fear throughout exposure trials as an index of corrective learning. However, the evidence, reviewed herein, indicates that neither the degree by which fear reduces nor the ending fear level predict therapeutic outcome. Developments in the theory and science of fear extinction, and learning and memory, indicate that 'performance during training' is not commensurate with learning at the process level. Inhibitory learning is recognized as being central to extinction and access to secondary inhibitory associations is subject to influences such as context and time, rather than fear during extinction training. Strategies for enhancing inhibitory learning, and its retrieval over time and context, are reviewed along with their clinical implications for exposure therapy and directions for future research.

Craske MG, Waters AM. · Department of Psychology, University of California, Los Angeles, California 90095, USA. · Annu Rev Clin Psychol. · Pubmed #17716087 No free full text.

Abstract: This chapter provides a review of recent empirical developments, current controversies, and areas in need of further research in relation to factors that are common as well as specific to the etiology and maintenance of panic disorder, phobias, and generalized anxiety disorder. The relative contribution of broad risk factors to these disorders is discussed, including temperament, genetics, biological influences, cognition, and familial variables. In addition, the role that specific learning experiences play in relation to each disorder is reviewed. In an overarching hierarchical model, it is proposed that generalized anxiety disorder, and to some extent panic disorder, loads most heavily on broad underlying factors, whereas specific life history contributes most strongly to circumscribed phobias.

Roy-Byrne PP, Craske MG, Stein MB. · Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine at Harborview Medical Center, Seattle, WA 98104-2499, USA. · Lancet. · Pubmed #16980119 No free full text.

Abstract: Panic disorder is a common mental disorder that affects up to 5% of the population at some point in life. It is often disabling, especially when complicated by agoraphobia, and is associated with substantial functional morbidity and reduced quality of life. The disorder is also costly for individuals and society, as shown by increased use of health care, absenteeism, and reduced workplace productivity. Some physical illnesses (eg, asthma) commonly occur with panic disorder, and certain lifestyle factors (eg, smoking) increase the risk for the disorder, but causal pathways are still unclear. Genetic and early experiential susceptibility factors also exist, but their exact nature and pathophysiological mechanisms remain unknown. Despite an imprecise, although increased, understanding of cause, strong evidence supports the use of several effective treatments (eg, pharmacological, cognitive-behavioural). The adaptation and dissemination of these treatments to the frontlines of medical-care delivery should be urgent goals for the public-health community.

Demertzis KH, Craske MG. · UCLA Department of Psychology, 405 Hilgard Avenue, Box 951563, Los Angeles, CA 90095-1563, USA. · Curr Psychiatry Rep. · Pubmed #16879793 No free full text.

Abstract: Anxiety disorders are common within primary care (PC) settings and are associated with patient functional impairment, distress, and high utilization of medical care services. Data from PC settings indicate that detection of anxiety disorders is low. Furthermore, adequate psychosocial and pharmacologic treatment of anxiety disorders in accordance with empirically validated guidelines remains low in PC. When patients do receive treatment or referrals from their PC providers, a bias exists for pharmacologic over psychological interventions despite theoretical strengths, empirical evidence, and long-term cost efficiency supporting the use of psychotherapeutic interventions such as cognitive-behavioral therapy (CBT). Objectives of this article include increasing awareness of the prevalence of anxiety disorders in PC, impairment associated with anxiety disorders, issues of detection of anxiety in PC, treatment model and components of CBT, and data supporting the application of CBT to PC to improve patient functioning.

Craske MG, Tsao JC. · Department of Psychology, University of California, 405 Hilgard Ave., Los Angeles, CA 90095-1563, USA. · Sleep Med Rev. · Pubmed #15893248 No free full text.

Abstract: Nocturnal panic (NP), waking from sleep in a state of panic, is a common occurrence among patients with panic disorder, with 44-71% reporting at least one such attack. NP is a non-REM event that is distinct from sleep terrors, sleep apnea, nightmares or dream-induced arousals. This review outlines recent advances in the characterization of NP, as well as current approaches to the assessment and treatment of NP. In contrast to earlier work, more recent studies suggest that patients with NP do not differ from patients without NP on sleep architecture, sleep physiology, self-reported sleep quality and severity of panic disorder. However, more precise measurement of physiological precipitants and features is warranted. Assessment of NP focuses on ruling out other explanations for NP, with differential diagnosis based on interviews, sleep polysomnography and ambulatory recording of sleep. Psychological treatment (cognitive-behavioral therapy) targets misappraisals of anxiety sensations, hyperventilatory response, and conditioned reactions to internal, physical cues. Recent evidence supports the efficacy of this approach, however, controlled studies on pharmacological agents in the treatment of NP are lacking. Research is needed to examine the effects of combined cognitive-behavioral therapy and medications, compared to medication alone in the treatment of NP.

Craske MG, Pontillo DC. · Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA. · Bull Menninger Clin. · Pubmed #11280959 No free full text.

Abstract: Cognitive theorists hypothesize that cognitive biases are a major component in the development and maintenance of anxiety disorders. These include attentional biases toward threat-related information, distorted judgments of risk, and selective memory processing. The empirical evidence for these cognitive biases in anxiety disorder populations is reviewed. Potential deleterious effects of these biases on the process of cognitive-behavioral therapy are also discussed, as are possible ways of overriding those effects and maximizing treatment efficacy.

Aikins DE, Craske MG. · Division of Adult Psychiatry, Department of Psychiatry, University of California, Los Angeles, USA. · Psychiatr Clin North Am. · Pubmed #11225509 No free full text.

Abstract: The hallmark feature of generalized anxiety disorder, worry, has been hypothesized to be a key factor in the production of threat-related information-processing biases in the domains of attention, memory, interpretation of ambiguity, and problem solving; however, worry and cognitive biases are not unique to generalized anxiety disorder. What may be unique to generalized anxiety disorder is the pervasive use of worry as a strategy to avoid intense negative effect and the broad domains in which these biases are exhibited, directly relating to the clinical observation that patients with generalized anxiety disorder worry about numerous life stressors. Also, the authors conclude that information-processing biases contribute to worry but that they are insufficient for the development of generalized anxiety disorder. Directions for future research and clinical implications are discussed.

Tsao JC, Mystkowski JL, Zucker BG, Craske MG. · Department of Pediatrics, David Geffen School of Medicine, UCLA, 10940 Wilshire Blvd., Suite 1450, Los Angeles, CA 90024, USA. · Behav Res Ther. · Pubmed #15896289 No free full text.

Abstract: This study examined the effects of cognitive-behavioral therapy (CBT) for principal panic disorder with or without agoraphobia, on comorbidity in 30 individuals (16 female). To test the hypothesis that improvements in co-existing conditions were not due to spontaneous fluctuations across time, patients receiving immediate CBT were compared to those assigned to wait list (n = 11). Results indicated clinician-rated severity of comorbid specific phobia declined significantly following immediate CBT compared to no change after wait list. The number of patients without comorbidity of any severity increased after immediate CBT, with no such increase following wait list. However, the groups did not differ in the frequency of additional diagnoses or overall severity of comorbidity. In the total sample, results indicated reductions in comorbidity by 9-month follow-up, with marked declines in the severity of comorbid generalized anxiety disorder (GAD), social and specific phobia. Our findings suggest that targeted CBT for panic disorder has beneficial effects on comorbidity over the longer term and that some of its immediate effects exceed those due to the passage of time alone.

Roy-Byrne PP, Craske MG, Stein MB, Sullivan G, Bystritsky A, Katon W, Golinelli D, Sherbourne CD. · Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine at Harborview Medical Center, Seattle, USA. · Arch Gen Psychiatry. · Pubmed #15753242 links to  free full text

Abstract: BACKGROUND: Panic disorder is a prevalent, often disabling condition among patients in the primary care setting. Although numerous studies have assessed the effectiveness of treatments for depression in primary care, few such studies have been conducted for panic disorder. OBJECTIVE: To implement and test the effectiveness of a combined pharmacotherapy and cognitive-behavioral intervention for panic disorder tailored to the primary care setting. DESIGN: Randomized, controlled study comparing intervention to treatment as usual. SETTING: Six primary care clinics associated with 3 university medical schools, serving an ethnically and socioeconomically diverse patient population. PARTICIPANTS: Two hundred thirty-two primary care patients meeting DSM-IV criteria for panic disorder. Comorbid mental and physical disorders were permitted, provided these did not contraindicate the treatment to be provided and were not acutely life threatening. INTERVENTION: Patients were randomized to receive either treatment as usual or an intervention consisting of a combination of up to 6 sessions (across 12 weeks) of cognitive-behavioral therapy (CBT) modified for the primary care setting, with up to 6 follow-up telephone contacts during the next 9 months, and algorithm-based pharmacotherapy provided by the primary care physician with guidance from a psychiatrist. Behavioral health specialists, the majority inexperienced in CBT for panic disorder, were trained to deliver the CBT and coordinated overall care, including pharmacotherapy. MAIN OUTCOMES MEASURES: Proportion of subjects remitted (no panic attacks in the past month, minimal anticipatory anxiety, and agoraphobia subscale score <10 on Fear Questionnaire) and responding (Anxiety Sensitivity Index score <20) and change over time in World Health Organization Disability Scale and short form 12 scores. RESULTS: The combined cognitive-behavioral and pharmacotherapeutic intervention resulted in sustained and gradually increasing improvement relative to treatment as usual, with significantly higher rates at all points of both the proportion of subjects remitted (3 months, 20% vs 12%; 12 months, 29% vs 16%) and responding (3 months, 46% vs 27%; 12 months, 63% vs 38%) and significantly greater improvements in World Health Organization Disability Scale (all points) and short form 12 mental health functioning (3 and 6 months) scores. These effects were obtained in spite of similar rates of delivery of guideline-concordant pharmacotherapy to the 2 groups. CONCLUSION: Delivery of evidence-based CBT and medication using the collaborative care model and a CBT-naive, midlevel behavioral health specialist is feasible and significantly more effective than usual care for primary care panic disorder.

Craske MG, DeCola JP, Sachs AD, Pontillo DC. · Department of Psychology, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA. · J Anxiety Disord. · Pubmed #12727125 No free full text.

Abstract: The goal of the present study was to compare the efficacy of cognitive-behavioral treatment for panic control alone versus this treatment containing an additional in vivo exposure component. The sample was comprised of 68 individuals who met diagnosis for panic disorder with agoraphobia. Participants were randomly assigned to one of two 16-week treatment conditions, panic control only and panic control with in vivo exposure. Assessments were repeated at baseline, mid-treatment, posttreatment, and 6-month follow-up using diagnostic and behavioral measures. Results indicated that the two treatment conditions were equally efficacious for both panic disorder and agoraphobia. The intervention explicitly targeting agoraphobia appeared superfluous given the efficacy of panic control alone. On the other hand, reduction in panic frequency predicted reduction in agoraphobic avoidance overall. The practical and theoretical implications are discussed, as are limitations and directions for future research.

Wetherell JL, Gatz M, Craske MG. · Department of Psychiatry, University of California, San Diego and VA San Diego Healthcare System 92161, USA. · J Consult Clin Psychol. · Pubmed #12602423 No free full text.

Abstract: Older adults with generalized anxiety disorder (GAD; N = 75; M age = 67.1 years) were randomly assigned to cognitive-behavioral therapy (CBT), a discussion group (DG) organized around worry-provoking topics, or a waiting period. Participants in both active conditions improved relative to the waiting list. Although CBT participants improved on more measures than DG participants, the authors found only I significant difference immediately after treatment and no differences at 6-month follow-up. Effect sizes were smaller than in younger samples, but CBT showed large effects and DG showed medium-sized effects Overall, results indicate that brief treatment of late-life GAD is beneficial, but they provide only limited support for the superiority of CBT to a credible comparison intervention.

Hazlett-Stevens H, Craske MG, Roy-Byrne PP, Sherbourne CD, Stein MB, Bystritsky A. · University of California, Los Angeles, CA, USA. · Gen Hosp Psychiatry. · Pubmed #12220797 No free full text.

Abstract: The purpose of this investigation was to identify demographic and clinical patient characteristics related to willingness to consider panic disorder treatments in the primary care setting. Given the prevalence of anxiety disorders and the increased provision of mental health treatments in general medical settings, patients were selected from primary care settings. An unselected sample of 4,198 patients completed a brief questionnaire containing questions about demographic characteristics, physical health status, and symptoms of panic disorder, social phobia and PTSD. The 1,043 patients indicating a recent panic attack episode answered additional questions about their willingness to consider both medication and psychosocial forms of intervention for panic. Of these panic patients, 64% reported willingness to consider medication and 67% reported willingness to consider a psychosocial intervention for their panic. Logistic regression analyses for these panic patients revealed that willingness to consider medication treatment for panic was associated with older age, lower education, poorer health status and the presence of social phobia and/or PTSD symptoms. In addition, Asian and African American patients were less likely than Caucasian patients to indicate willingness to consider medication treatment for their panic. However, only the presence of comorbid social phobia and PTSD symptoms predicted willingness to consider a psychosocial intervention. Results suggest that acceptability of psychosocial treatment is unrelated to demographic and physical health factors, while primary care patients with certain demographic characteristics, good physical health, or who suffer from fewer comorbid mental health conditions may need additional encouragement to begin medication treatment for panic.

Zucker BG, Craske MG, Barrios V, Holguin M. · University of California, Los Angeles, Department of Psychology, 90095, USA. · Behav Res Ther. · Pubmed #12051484 No free full text.

Abstract: The goal of this study was to investigate whether or not a brief educational intervention delivered prior to engaging in an anxiety-provoking task (writing a sentence about hoping that a friend/relative was in a car accident) would be effective in offsetting anxiety in college students with a strong propensity to endorse statements of thought action fusion (TAF). As hypothesized, individuals receiving the educational intervention were less anxious than a placebo intervention control group at post task; they were also less likely to endorse statements of TAF after receiving the educational intervention. Also, those who chose to neutralize after writing the sentence (regardless of experimental group) were more likely to report feeling guiltier, more immoral and a greater sense of responsibility about writing the sentence prior to neutralizing than those who did not subsequently neutralize. These results are discussed in relation to the cognitive theory of obsessive-compulsive disorder and implications for prevention programs.

Rodriguez BI, Craske MG, Mineka S, Hladek D. · University of California, Los Angeles, USA. · Behav Res Ther. · Pubmed #10458048 No free full text.

Abstract: Context-specificity of fear extinction was tested among 65 participants who were fearful of spiders by manipulating the contexts used for exposure treatment and two-week follow-up assessment. Context was defined by both meaningful (presence of a particular therapist) and incidental (room location and furnishings) environmental cues. Distinct phobic stimuli were used to examine interactions of context with stimulus. Physiological, behavioral and verbal indices of fear were measured. Results provided modest support for context-specific return of fear. With one stimulus, participants assessed in a non-treatment context at follow-up exhibited greater returns in heart rate levels. In addition, three of four participants who could not touch the stimulus at follow-up had been tested in a non-treatment context. Future investigations may benefit from greater distinctions between contexts or manipulation of contextual features more directly relevant to fear. Finally, post hoc analyses identified high trait anxiety, slow treatment response, recovery of phobic cognitions and long duration/high intensity phobic encounters post-treatment as significant predictors of increased return of fear.

Segerstrom SC, Glover DA, Craske MG, Fahey JL. · Department of Psychology, University of Kentucky, Lexington, Kentucky 40506-0044, USA. · Brain Behav Immun. · Pubmed #10373274 No free full text.

Abstract: Worry, the cognitive enumeration and anticipation of potential future negative events, is associated with autonomic dysregulation, which may in turn have implications for the immune system. People endorsing high (n = 7) and normal levels of trait worry (n = 8) were briefly exposed to a phobic stimulus and the autonomic and immune responses and recovery were assessed. A time-matched control group (n = 6) was not exposed to any stimulus. Both worry groups showed increased heart rate and skin conductance in response to phobic fear. However, only the normal worry group showed a concomitant increase in natural killer cells in peripheral blood. Patterns of change during the follow-up period suggested that phobic fear had disrupted a normal circadian increase in natural killer cells. Adrenergic and hypothalamus-pituitary-adrenal mechanisms may be responsible for the differences between high and normal worry groups in their natural killer cell response to and recovery from phobic fear.

Roy-Byrne P, Veitengruber JP, Bystritsky A, Edlund MJ, Sullivan G, Craske MG, Welch SS, Rose R, Stein MB. · Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations, Seattle, USA. · J Am Board Fam Med. · Pubmed #19264941 links to  free full text

Abstract: To address the difficulty of assessing and managing multiple anxiety disorders in the primary care setting, this article provides a simple, easy-to-learn, unified approach to the diagnosis, care management, and pharmacotherapy of the 4 most common anxiety disorders found in primary care: panic, generalized anxiety disorders, social anxiety disorders, and posttraumatic stress disorder. This evidence-based approach was developed for an ongoing National Institute of Mental Health-funded study designed to improve the delivery of evidence-based medication and psychotherapy treatment to primary care patients with these anxiety disorders. We present a simple, validated method to screen for the 4 major disorders that emphasizes identifying other medical or psychiatric comorbidities that can complicate treatment; an approach for initial education of the patient and discussion about treatment, including provision of some simple cognitive behavioral therapy skills, based on motivational interviewing/brief intervention approaches previously used for substance use disorders; a validated method for monitoring treatment outcome; and an algorithmic approach for the selection of initial medication treatment, the selection of alternative or adjunctive treatments when the initial approach has not produced optimal results, and indications for mental health referral.

Craske MG, Rose RD, Lang A, Welch SS, Campbell-Sills L, Sullivan G, Sherbourne C, Bystritsky A, Stein MB, Roy-Byrne PP. · Department of Psychology, University of California, Los Angeles, California, USA. · Depress Anxiety. · Pubmed #19212970 No free full text.

Abstract: OBJECTIVES: This article describes a computer-assisted cognitive behavioral therapy (CBT) program designed to support the delivery of evidenced-based CBT for the four most commonly occurring anxiety disorders (panic disorder, posttraumatic stress disorder, generalized anxiety disorder, and social anxiety disorder) in primary-care settings. The purpose of the current report is to (1) present the structure and format of the computer-assisted CBT program, and (2) to present evidence for acceptance of the program by clinicians and the effectiveness of the program for patients. METHODS: Thirteen clinicians using the computer-assisted CBT program with patients in our ongoing Coordinated Anxiety Learning and Management study provided Likert-scale ratings and open-ended responses about the program. Rating scale data from 261 patients who completed at least one CBT session were also collected. RESULTS: Overall, the program was highly rated and modally described as very helpful. Results indicate that the patients fully participated (i.e., attendance and homework compliance), understood the program material, and acquired CBT skills. In addition, significant and substantial improvements occurred to the same degree in randomly audited subsets of each of the four primary anxiety disorders (N=74), in terms of self ratings of anxiety, depression, and expectations for improvement. CONCLUSIONS: Computer-assisted CBT programs provide a practice-based system for disseminating evidence-based mental health treatment in primary-care settings while maintaining treatment fidelity, even in the hands of novice clinicians.

Naliboff BD, Waters AM, Labus JS, Kilpatrick L, Craske MG, Chang L, Negoro H, Ibrahimovic H, Mayer EA, Ornitz E. · Center for Neurobiology of Stress, Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, California, USA. · Psychosom Med. · Pubmed #18842745 No free full text.

Abstract: BACKGROUND AND AIMS: Visceral hypersensitivity and symptom severity in Irritable Bowel Syndrome (IBS) are both exacerbated by stress. The eye-blink startle response represents a noninvasive measure of central defensive responding. Evidence for central hyperexcitability was studied in IBS patients by examining potentiation of the startle reflex to a nociceptive threat. METHODS: Acoustic startle responses were examined in female IBS patients (n = 42) and healthy controls (n = 22) during cued periods in which an aversive abdominal or biceps stimulation was impossible (safe), possible (imminent threat) or anticipated (period just before the imminent threat), and during a threatening context (muscle stimulation pads attached but no cues for stimulation). RESULTS: Both groups showed potentiation of startle responses during the imminent threat condition compared with both the anticipation and safe conditions. Compared with controls, IBS subjects showed significantly larger startle responses during anticipation and imminent threat conditions after receiving an initial aversive stimulation. There were no group differences during the context threat manipulation. Moreover, in IBS patients but not controls, higher neuroticism was associated with larger startle responses during safe and anticipation conditions but not imminent threat, whereas anxiety symptoms were negatively associated with startle magnitude during imminent threat. CONCLUSIONS: Female IBS patients show increased startle responses to threat of aversive stimulation at both abdominal and nonabdominal sites compared with controls. The data represent the first demonstration of altered threat potentiated startle in a functional pain condition and provide support for the use of these paradigms in further evaluation of affective mechanisms in these disorders.

Craske MG, Waters AM, Nazarian M, Mineka S, Zinbarg RE, Griffith JW, Naliboff B, Ornitz EM. · Department of Psychology, University of California at Los Angeles, California, USA. · Biol Psychiatry. · Pubmed #18789433 No free full text.

Abstract: BACKGROUND: This study evaluated the relationship between neuroticism (N), a probable risk factor for emotional disorders, and modulation of startle reflexes (SRs). METHODS: One hundred thirty-two adolescents with varying levels of N but without anxiety or depressive disorders were evaluated in contextual cue and explicit threat cue paradigms. RESULTS: Within the explicit threat cue paradigm, N potentiated SRs more in conditions that were intermediately associated with threat of an aversive biceps contraction than conditions that were the furthest from and conditions that were the closest to the same threat. Also, N potentiated SRs across the entire experiment, regardless of experimental conditions, in male and not in female subjects. CONCLUSIONS: These results suggest that adolescents with high levels of N show greater sensitivity to contexts intermediately associated with threat. Results are discussed in comparison with other studies of groups at risk for anxiety and depressive disorders.

Waters AM, Craske MG, Bergman RL, Naliboff BD, Negoro H, Ornitz EM. · School of Psychology, Griffith University, Gold Coast, Qld, Australia. · Int J Psychophysiol. · Pubmed #18718853 No free full text.

Abstract: The present study examined the development of elevated startle reactivity in anticipation of mild anxiogenic procedures in school-age children with current anxiety disorders and in those at-risk for their development due to parental anxiety. Startle blink reflexes and skin conductance responses were assessed in 7 to 12 year old anxious children (N=21), non-anxious children at-risk for anxiety by virtue of parental anxiety disorder status (N=16) and non-anxious control children of non-anxious parents (N=13). Responses were elicited by 28 auditory startle stimuli presented prior to undertaking mild anxiogenic laboratory procedures. Results showed that group differences in startle reactivity differed as a function of children's age. Relative to control children for whom age had no effect, startle reflex magnitude in anticipation of anxiogenic procedures increased across the 7 to 12 years age range in children at-risk for anxiety disorders, whereas elevations in startle reactivity were already manifest from a younger age in children with anxiety disorders. These findings may suggest an underlying vulnerability that becomes manifest with development in offspring of anxious parents as the risk for anxiety disorders increases.

Story TJ, Craske MG. · University of California, Los Angeles, CA, USA. · Behav Res Ther. · Pubmed #18692167 No free full text.

Abstract: Participants with elevated anxiety sensitivity and a history of panic attacks were compared to a low anxiety comparison group with respect to physiological and subjective reactivity to false heart-rate feedback and reactivity to a priming procedure. Whereas accurate heart-rate feedback elicited minimal responses, participants across groups showed significant physiological and subjective responses to false feedback. High risk and low risk participants did not differ in heart-rate responses to false feedback, though panic attack frequency did predict physiological and subjective reactions to false feedback in the high risk group. Self-reported nonspecific anxiety was significantly higher in high risk female participants than in low risk female participants, while males did not different in general subjective anxiety. However, high risk participants reported more panic-specific symptoms during the false feedback task than low risk participants, regardless of the sex of the participant. Therefore, although the experimental paradigm appeared to trigger nonspecific anxiety in high risk female participants, panic attack symptoms in reaction to the task were specific to risk group, not sex, and consistent with hypotheses. Surprisingly, the priming procedure did not influence physiological or subjective responses to false feedback in either group. These results raise additional questions regarding the process and impact of interception in individuals with panic attacks, and suggest that false perception of internal changes may contribute to risk for panic disorder when exposed to believable cues.

Craske MG, Waters AM, Lindsey Bergman R, Naliboff B, Lipp OV, Negoro H, Ornitz EM. · UCLA Department of Psychology, Franz Hall, University of California, 405 Hilgard Avenue, Los Angeles, CA 90095-1563, USA. · Behav Res Ther. · Pubmed #18539262 No free full text.

Abstract: Aversive conditioning and extinction were evaluated in children with anxiety disorders (n=23), at-risk for anxiety disorders (n=15), and controls (n=11). Participants underwent 16 trials of discriminative conditioning of two geometric figures, with (CS+) or without (CS-) an aversive tone (US), followed by 8 extinction trials (4 CS+, 4 CS-), and 8 extinction re-test trials averaging 2 weeks later. Skin conductance responses and verbal ratings of valence and arousal to the CS+/CS- stimuli were measured. Anxiety disordered children showed larger anticipatory and unconditional skin conductance responses across conditioning, and larger orienting and anticipatory skin conductance responses across extinction and extinction re-test, all to the CS+ and CS-, relative to controls. At-risk children showed larger unconditional responses during conditioning, larger orienting responses during the first block of extinction, and larger anticipatory responses during extinction re-test, all to the CS+ and CS-, relative to controls. Also, anxiety disordered children rated the CS+ as more unpleasant than the other groups. Elevated skin conductance responses to signals of threat (CS+) and signals of safety (CS-; CS+ during extinction) are discussed as features of manifestation of and risk for anxiety in children, compared to the specificity of valence judgments to the manifestation of anxiety.

Campbell-Sills L, Norman SB, Craske MG, Sullivan G, Lang AJ, Chavira DA, Bystritsky A, Sherbourne C, Roy-Byrne P, Stein MB. · Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0603, USA. · J Affect Disord. · Pubmed #18486238 No free full text.

Abstract: BACKGROUND: The Overall Anxiety Severity and Impairment Scale (OASIS) is a 5-item self-report measure that can be used to assess severity and impairment associated with any anxiety disorder or multiple anxiety disorders. A prior investigation with a nonclinical sample supported the reliability and validity of the OASIS; however, to date it has not been validated for use in clinical samples. METHODS: The present study assessed the psychometric properties of the OASIS in a large sample (N=1036) of primary care patients whose physicians referred them to an anxiety disorders treatment study. Latent structure, internal consistency, convergent/discriminant validity, and cut-score analyses were conducted. RESULTS: Exploratory and confirmatory factor analyses supported a unidimensional structure. The five OASIS items displayed strong loadings on the single factor and had a high degree of internal consistency. OASIS scores demonstrated robust correlations with global and disorder-specific measures of anxiety, and weak correlations with measures of unrelated constructs. A cut-score of 8 correctly classified 87% of this sample as having an anxiety diagnosis or not. LIMITATIONS: Convergent validity measures consisted solely of other self-report measures of anxiety. Future studies should evaluate the convergence of OASIS scores with clinician-rated and behavioral measures of anxiety severity. CONCLUSIONS: Overall, this investigation suggests that the OASIS is a valid instrument for measurement of anxiety severity and impairment in clinical samples. Its brevity and applicability to a wide range of anxiety disorders enhance its utility as a screening and assessment tool.

Kircanski K, Craske MG, Bjork RA. · Department of Psychology, University of California, Los Angeles, CA 90095-1563, USA. · Behav Res Ther. · Pubmed #18308292 No free full text.

Abstract: The current study examined the impact of thought suppression on indices of anxiety, including memory indices (implicit and explicit memory biases) and physiological indices (heart rate). The participants, 81 undergraduates scoring in the top quartile of a self-report measure of trait anxiety, were randomly assigned to one of three experimental groups: thought suppression (TS), thought concentration (TC), and thought wandering (TW). The TC and TW groups were included to control for the effects of effortful processing and exposure to stimuli, respectively. One block of threat words and one block of neutral words were presented under conditions of cognitive load, and participants' physiological responses and memory biases were measured. The thought suppression group exhibited an enhanced overall memory bias for threat words, driven by an elevated explicit memory bias, relative to the other two groups, a result that has implications for ironic processes theory and may inform information-processing models of anxiety.

Waters AM, Wharton TA, Zimmer-Gembeck MJ, Craske MG. · School of Psychology, Griffith University, Gold Coast Australia, Queensland 9726, Australia. · Behav Res Ther. · Pubmed #18304519 No free full text.

Abstract: Attention and interpretation biases for threat stimuli were assessed in 19 anxious (ANX) children before and after cognitive behavioural therapy (CBT), and compared with responses from 19 non-anxious (NA) control children collected over the same period. Attentional bias was assessed using a picture version of the visual probe task with threat, neutral and pleasant pictures. Threat interpretation bias was assessed using both a homographs task in which children used homograph words in a sentence and their neutral or threatening meaning was assessed, and a stories task in which children rated their negative emotion, danger judgments, and influencing ability in ambiguous situations. ANX children showed attention biases towards threat on the visual probe task and threat interpretation biases on the stories task but not the homographs task at pre-treatment in comparison with NA children. Following treatment, ANX children's threat interpretation biases as assessed on the stories task reduced significantly to within levels comparable to NA children. However, ANX children continued to show larger attentional biases towards threat than pleasant pictures on the visual probe task at post-treatment, whereas NA children did not show attentional biases. Moreover, a residual threat interpretation style on the stories task at post-treatment was associated with higher anxiety symptoms in both ANX and NA children.