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1.  A Prospective Investigation of Emotion Dysregulation as a Moderator of the Relation between Posttraumatic Stress Symptoms and Substance Use Severity 
Despite strong evidence for an association between the experience of posttraumatic stress (PTS) symptoms and substance use, little is known about the particular individuals most at-risk for problematic substance use in response to PTS symptoms. Consequently, the goal of this study was to conduct a prospective investigation of the moderating role of emotion dysregulation (assessed through self-report and behavioral measures) in the relation between PTS symptoms and substance use 8-months later within a sample of 106 young adult women. No main effect of PTS symptoms on substance use was found. Instead, PTS symptoms were only associated with later substance use in the context of heightened emotion dysregulation. Results provide support for emotion dysregulation as a key factor that may increase risk for substance use among women experiencing PTS symptoms and highlight a target for future interventions aimed at reducing risk for the development of maladaptive behaviors stemming from PTS symptoms.
doi:10.1016/j.janxdis.2014.11.003
PMCID: PMC4749400  PMID: 25483275
emotion regulation; longitudinal; moderation; posttraumatic stress disorder; self-medication; trauma
2.  Perception Matters for Clinical Perfectionism and Social Anxiety 
Despite research documenting a relationship between social anxiety and perfectionism, very little research has examined the relationship between social anxiety and clinical perfectionism, defined as the combination of high personal standards and high maladaptive perfectionistic evaluative concern. In the current studies we examined whether clinical perfectionism predicted social anxiety in a large sample of undergraduates (N = 602), in a clinical sample of participants diagnosed with social anxiety disorder (SAD; N = 180), and by using a variance decomposition model of self-and informant-report of perfectionism (N = 134). Using self-report, we found that an interaction of personal standards and evaluative concern predicted both social interaction anxiety and fear of scrutiny, but not in the theorized direction. Specifically, we found that self-report of low standards and high evaluative concern was associated with the highest levels of social anxiety, suggesting that when individuals with SAD hold low expectations for themselves combined with high concerns about evaluation, social anxiety symptoms may increase. Alternatively, when an informants’ perspective was considered, and more consistent with the original theory, we found that the interaction of informant-only report of personal standards and shared-report (between both primary participant and informant) of concern over mistakes was associated with self-reported social anxiety, such that high concern over mistakes and high personal standards predicted the highest levels of social anxiety. Theoretical, clinical, and measurement implications for clinical perfectionism are discussed.
doi:10.1016/j.janxdis.2014.11.002
PMCID: PMC4315707  PMID: 25486087
perfectionism; clinical perfectionism; social anxiety; high standards; social anxiety disorder
3.  Reliability and Validity of the Dimensional Features of Generalized Anxiety Disorder 
The reliability and validity of the dimensional features of generalized anxiety disorder (GAD) were examined in a diverse sample of 508 outpatients with anxiety and mood disorders who underwent two independent administrations of the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L; Di Nardo, Brown, & Barlow, 1994). Inter-rater reliability was higher in the full sample than in patients with current GAD. Additionally, the presence of a mood disorder weakened inter-rater reliability. We also explored the unique contribution of excessiveness and uncontrollability of worry to various clinical outcomes and found that excessiveness predicted anxiety, depression, and stress self-report measures, and uncontrollability predicted clinical severity and number of diagnoses. Findings are discussed with regard to their implications for the classification of GAD (e.g., utility of dimension-based assessment to improve the classification of psychological disorders).
doi:10.1016/j.janxdis.2014.10.003
PMCID: PMC4315716  PMID: 25465882
GAD; reliability; validity; dimensional classification; diagnostic criteria
4.  Social Anxiety, Acute Social Stress, and Reward Parameters Interact to Predict Risky Decision-Making among Adolescents 
Risk-taking behavior increases during adolescence, leading to potentially disastrous consequences. Social anxiety emerges in adolescence and may compound risk-taking propensity, particularly during stress and when reward potential is high. However, the manner in which social anxiety, stress, and reward parameters interact to impact adolescent risk-taking is unclear. To clarify this question, a community sample of 35 adolescents (15 to 18 yo), characterized as having high or low social anxiety, participated in a 2-day study, during each of which they were exposed to either a social stress or a control condition, while performing a risky decision-making task. The task manipulated, orthogonally, reward magnitude and probability across trials. Three findings emerged. First, reward magnitude had a greater impact on the rate of risky decisions in high social anxiety (HSA) than low social anxiety (LSA) adolescents. Second, reaction times (RTs) were similar during the social stress and the control conditions for the HSA group, whereas the LSA group’s RTs differed between conditions. Third, HSA adolescents showed the longest RTs on the most negative trials. These findings suggest that risk-taking in adolescents is modulated by context and reward parameters differentially as a function of social anxiety.
doi:10.1016/j.janxdis.2014.10.001
PMCID: PMC4315762  PMID: 25465884
gambling; wheel of fortune; expected value; uncertainty; youths
5.  Expressive inhibition in response to stress: Implications for emotional processing following trauma 
Journal of anxiety disorders  2014;29:109-118.
Expressive inhibition - the willful restriction of expressed emotion - is documented in individuals reporting trauma-related distress, but its impact on global affective functioning remains unclear. Theoretical models propose that chronic activation of negative emotion and deliberate restriction of affect operate synergistically to produce trauma-related emotional deficits. The current project examined the impact of these factors on subjective experience and physiological activation following exposure to an analog trauma. University students (N = 192; Mage = 20, 57% female, 42% White/Non-Hispanic) viewed a graphic film depicting scenes of a televised suicide. Participants then viewed either a sadness- or humor-eliciting film under instructions to inhibit [nsadness = 45, nhumor = 52] or naturally express emotion [nsadness = 48, nhumor = 47]. Expressive inhibition was associated with restricted amusement specifically among participants viewing the humor film. Inhibition also produced attenuated sympathetic and parasympathetic recovery, irrespective of film assignment. Evidence of disruptions in emotional processing supports models identifying inhibition as a possible mechanism in post-trauma affect dysregulation.
doi:10.1016/j.janxdis.2014.11.008
PMCID: PMC4327836  PMID: 25576773
Emotion regulation; Expressive inhibition; Trauma; PTSD
6.  Inattention symptoms and the diagnosis of comorbid attention-deficit/hyperactivity disorder among youth with generalized anxiety disorder 
Journal of anxiety disorders  2014;28(8):754-760.
Generalized anxiety disorder (GAD) and attention-deficit/hyperactivity disorder (ADHD) commonly co-occur in childhood. Inattention symptoms can be hallmarks of both conditions, however assessment tools of inattention may not effectively distinguish between the two conditions. The present study used receiver operating characteristic (ROC) analyses to examine the high-end specificity of the Attention Problems Scale of the Child Behavior Checklist (CBCL) for detecting comorbid ADHD among youth with GAD (N = 46). Results support the utility of the Attention Problems Scale for accurately distinguishing between the two groups (AUC = 0.84, SE = .06). Specifically, a cut score of 63 achieved the most favorable values across diagnostic utility indices; 74% of GAD youth with ADHD scored above this cutoff and 91% of GAD youth without ADHD scored below this cutoff. Findings provide support for the use of the CBCL Attention Problems Scale to supplement diagnostic interviews and identify inattention associated with ADHD among GAD youth.
doi:10.1016/j.janxdis.2014.09.003
PMCID: PMC4252769  PMID: 25260213
attention-deficit/hyperactivity disorder; Child Behavior Checklist; generalized anxiety disorder; high-end specificity; inattention
7.  Parental accommodation of child anxiety and related symptoms: Range, impact, and correlates 
Journal of anxiety disorders  2014;28(8):765-773.
Parental accommodation—i.e., changes in parents’ behavior in attempts to prevent or reduce child distress—has been most studied in relation to OCD. Although recent work suggests parents of children with non-OCD anxiety diagnoses also engage in accommodation, little is known about the specific forms, correlates, and associated interference of such accommodation. The present study examined the range and associated interference of parental accommodation behaviors using the newly developed Family Accommodation Checklist and Interference Scale (FACLIS) in a sample of the parents of 71 clinic-referred children with anxiety disorders (NMothers = 68; NFathers= 51). The FACLIS demonstrated good reliability and validity. Ninety-seven percent of mothers and 88% of fathers reported engaging in at least one type of accommodation in the previous two weeks, with parents reporting an average of roughly 4 interfering parental accommodation behaviors. Greater parental accommodation and associated interference were associated with higher maternal distress. Among the anxiety disorders, accommodation was most strongly associated with generalized and separation anxiety disorder, as well as specific phobias. Findings (a) offer psychometric support for the FACLIS as a reliable and valid tool for the assessment of accommodation range and impact, and (b) help clarify the considerable scope and interference associated with parental accommodation of childhood anxiety.
doi:10.1016/j.janxdis.2014.09.007
PMCID: PMC4254352  PMID: 25261837
Accommodation; anxiety; parents; transdiagnostic
8.  Predictors of CBT Outcome in Older Adults with GAD 
Journal of anxiety disorders  2014;28(8):845-850.
The current study is a secondary analysis of data from a randomized controlled trial of CBT for late-life GAD (Stanley et al., 2014) which provided an opportunity to examine predictors of outcome among those who received CBT. Participants were 150 older adults who were randomized to receive 10 sessions of CBT. Completer analyses found that homework completion, number of sessions attended, lower worry severity, lower depression severity, and recruitment site predicted 6-month worry outcome on the PSWQ-A, whereas homework completion, credibility of the therapy, lower anxiety severity, and site predicted better 6-month anxiety outcome on the STAI-T. In intent-to-treat multivariate analyses, however, only initial worry and anxiety severity, site, and number of sessions completed predicted treatment outcome. These results are largely consistent with predictors of outcome in younger adults and suggest that lower initial symptom severity and variables consistent with greater engagement in treatment predict outcome.
doi:10.1016/j.janxdis.2014.09.012
PMCID: PMC4254548  PMID: 25445074
generalized anxiety disorder; cognitive behavioral therapy; predictors of outcome; older adults
9.  The Impact of Social Skills Training For Social Anxiety Disorder: A Randomized Controlled Trial 
Journal of anxiety disorders  2014;28(8):908-918.
Objective:
Social anxiety disorder (SAD) impacts social, occupational and academic functioning. Although many interventions report change in social distress, improvement in social behavior remains under-addressed. This investigation examined the additive impact of social skills training (SST) for the treatment of SAD.
Method:
Using a sample of 106 adults who endorsed SAD across numerous social settings, participants were randomized to exposure therapy (imaginal and in vivo) alone, a combination of SST and exposure therapy known as Social Effectiveness Therapy (SET), or a wait list control. The assessment strategy included self-report measures, blinded clinical ratings and blinded assessment of social behavior.
Results:
Both interventions significantly reduced distress in comparison to the wait list control and at post-treatment, 67% of patients treated with SET and 54% of patients treated with exposure therapy alone no longer met diagnostic criteria for SAD, a difference that was not statistically significant. When compared to exposure therapy alone, SET produced superior outcomes (p<.05) on measures of social skill and general clinical status. In addition to statistical significance, participants treated with SET or exposure reported clinically significant decreases on two measures of self-reported social anxiety and several measures of observed social behavior (all ps < .05).
Conclusions:
Both interventions produced efficacious treatment outcome, although SET may provide additional benefit on measures of social distress and social behavior.
doi:10.1016/j.janxdis.2014.09.016
PMCID: PMC4254620  PMID: 25445081
generalized social anxiety disorder; exposure therapy; social skills training; Social Effectiveness Therapy; treatment of social anxiety disorder
10.  Interpretation Bias Modification for Youth and their Parents: A Novel Treatment for Early Adolescent Social Anxiety 
Journal of anxiety disorders  2014;28(8):851-864.
Social anxiety is the most prevalent anxiety disorder of late adolescence, yet current treatments reach only a minority of youth with the disorder. Effective and easy-to-disseminate treatments are needed. This study pilot tested the efficacy of a novel, online cognitive bias modification for interpretation (CBM-I) intervention for socially anxious youth and their parents. The CBM-I intervention targeted cognitive biases associated with early adolescents’ maladaptive beliefs regarding social situations, and with parents’ intrusive behavior, both of which have been theoretically linked with the maintenance of social anxiety in youth. To investigate the efficacy of intervening with parents and/or children, clinically diagnosed early adolescents (ages 10–15; N = 18) and their mothers were randomly assigned to one of three conditions: the first targeted early adolescents’ cognitive biases related to social anxiety (Child-only condition); the second targeted parents’ biases associated with intrusive behavior (Parent-only condition); and the third targeted both youth and parents’ biases in tandem (Combo condition). The use of a multiple baseline design allowed for the efficient assessment of causal links between the intervention and reduction in social anxiety symptoms in youth. Results provided converging evidence indicating modest support for the efficacy of CBM-I, with no reliable differences across conditions. Taken together, results suggest that online CBM-I with anxious youth and/or their parents holds promise as an effective and easily administered component of treatment for child social anxiety that deserves further evaluation in a larger trial.
doi:10.1016/j.janxdis.2014.09.011
PMCID: PMC4303587  PMID: 25445075
Cognitive bias modification; youth social anxiety; family-based treatment
11.  Attentional control mediates the effect of social anxiety on positive affect☆ 
Journal of anxiety disorders  2012;27(1):56-67.
The goal of the present studies was to examine whether attentional control, a self-regulatory attentional mechanism, mediates the effect of social anxiety on positive affect. We tested this mediation in two studies using undergraduate students selected to represent a broad range of severity of social anxiety. Self-report assessments of social anxiety, attentional control, and positive affect were collected in a cross-sectional design (Study 1) and in a longitudinal design with three assessment points (Study 2). Results of both studies supported the hypothesized mediational model. Specifically, social anxiety was inversely related to attentional control, which itself positively predicted positive affect. This mediation remained significant even when statistically controlling for the effects of depression. Additionally, the hypothesized model provided superior model fit to theoretically-grounded equivalent models in both studies. Implications of these findings for understanding diminished positive affect in social anxiety are discussed.
doi:10.1016/j.janxdis.2012.10.002
PMCID: PMC4598068  PMID: 23254261
Social anxiety; Attention; Attentional control; Positive affect
12.  Disgust as a Unique Affective Predictor of Mental Contamination Following Sexual Trauma 
Journal of anxiety disorders  2014;28(7):704-711.
Mental contamination has been described as an internal experience of dirtiness that can arise and persist in the absence of contact with observable physical contaminants. Recent research has examined mental contamination specifically related to unwanted physical contact and sexual trauma. This study evaluated the degree to which disgust propensity and both self-focused and perpetrator-focused peritraumatic disgust were associated with mental contamination in a sample of women who experienced sexual trauma (n = 72). Results showed that peritraumatic self-focused disgust, but not peritraumatic perpetrator-focused disgust or fear, was significantly associated with mental contamination. Additionally, disgust propensity contributed significantly to the incremental validity of the model. These findings support the nascent literature showing that disgust plays a significant role in mental contamination, particularly following sexual trauma. Future research directions, and clinical/theoretical implications of these results are discussed.
doi:10.1016/j.janxdis.2014.07.007
PMCID: PMC4160347  PMID: 25129888
disgust; mental contamination; sexual trauma; posttraumatic stress disorder
13.  Disseminating Treatment for Anxiety Disorders Step 2: Peer Recommendations to seek help 
Journal of anxiety disorders  2014;28(7):712-716.
Despite the high prevalence of and significant psychological burden caused by anxiety disorders, as few as 25% of individuals with these disorders seek treatment, and treatment seeking by African-Americans is particularly uncommon. This purpose of the current study was to gather information regarding the public’s recommendations regarding help-seeking for several anxiety disorders and to compare Caucasian and African-American participants on these variables. A community sample of 577 US adults completed a telephone survey that included vignettes portraying individuals with generalized anxiety disorder (GAD), social phobia/social anxiety disorder (SP/SAD), panic disorder (PD), and for comparison, depression. The sample was ½ Caucasian and ½ African American. Respondents were significantly less likely to recommend help-seeking for SP/SAD and GAD (78.8% and 84.3%, respectively) than for depression (90.9%). In contrast, recommendations to seek help for panic disorder were common (93.6%) and similar to rates found for depression. The most common recommendations were to seek help from a primary care physician (PCP). African Americans were more likely to recommend help-seeking for GAD than Caucasians. Findings suggested that respondents believed individuals with anxiety disorders should seek treatment. Given that respondents often recommended consulting a PCP, we recommend educating PCPs about anxiety disorders and empirically-supported interventions.
doi:10.1016/j.janxdis.2014.07.010
PMCID: PMC4160353  PMID: 25145571
anxiety disorders; dissemination; mental health literacy; treatment-seeking; race; treatment
14.  Identification of Anxiety Sensitivity Classes and Clinical Cut-Scores in a Sample of Adult Smokers: Results from a Factor Mixture Model 
Journal of anxiety disorders  2014;28(7):696-703.
Anxiety sensitivity (AS), a multidimensional construct, has been implicated in the development and maintenance of anxiety and related disorders. Recent evidence suggests that AS is a dimensional-categorical construct within individuals. Factor mixture modeling was conducted in a sample of 579 adult smokers (M age = 36.87 years, SD = 13.47) to examine the underlying structure. Participants completed the Anxiety Sensitivity Index-3 and were also given a Structured Clinical Interview for DSM-IV-TR. Three classes of individuals emerged, a high AS (5.2% of the sample), a moderate AS (19.0%), and a normative AS class (75.8%). A cut-score of 23 to identify high AS individuals, and a cut-score of 17 to identify moderate-to-high AS individuals were supported in this study. In addition, the odds of having a concurrent anxiety disorder (controlling for other Axis I disorders) were the highest in the high AS class and the lowest in the normative AS class.
doi:10.1016/j.janxdis.2014.07.006
PMCID: PMC4160366  PMID: 25128664
anxiety sensitivity; factor mixture modeling; anxiety disorders; clinical cut-score
15.  PTSD Symptom Severity and Psychiatric Comorbidity in Recent Motor Vehicle Accident Victims: A Latent Class Analysis 
Journal of anxiety disorders  2014;28(7):644-649.
We conducted a latent class analysis (LCA) on 249 recent motor vehicle accident (MVA) victims to examine subgroups that differed in posttraumatic stress disorder (PTSD) symptom severity, current major depressive disorder and alcohol/other drug use disorders (MDD/AoDs), gender, and interpersonal trauma history 6-weeks post-MVA. A 4-class model best fit the data with a resilient class displaying asymptomatic PTSD symptom levels/low levels of comorbid disorders; a mild psychopathology class displaying mild PTSD symptom severity and current MDD; a moderate psychopathology class displaying severe PTSD symptom severity and current MDD/AoDs; and a severe psychopathology class displaying extreme PTSD symptom severity and current MDD. Classes also differed with respect to gender composition and history of interpersonal trauma experience. These findings may aid in the development of targeted interventions for recent MVA victims through the identification of subgroups distinguished by different patterns of psychiatric problems experienced 6-weeks post-MVA.
doi:10.1016/j.janxdis.2014.06.009
PMCID: PMC4160376  PMID: 25124501
PTSD/Posttraumatic Stress Disorder; Depression; Alcoholism/Alcohol Use Disorder; Substance Use Disorder; Trauma; Intervention
16.  Aversive Responding to Safety Signals in Panic Disorder: The Moderating Role of Intolerance of Uncertainty 
Journal of anxiety disorders  2014;28(7):731-736.
An inability to inhibit aversive responding during conditions that signal safety may be a core dysfunction associated with anxiety disorders. However, there has been inconsistent evidence as to whether individuals with panic disorder (PD) exhibit aversive responding during safety signals. It is therefore possible that only certain subgroups of PD patients, particularly those with high levels of intolerance of uncertainty (IU), evidence this type of abnormal responding. The aim of the current study was to examine whether IU moderates the association between PD and startle potentiation during a) safety and b) threat periods during a threat-of-shock task. Participants included 172 adults, 74 of which had current diagnoses of PD. Results indicated that at high levels of IU, PD was associated with greater startle potentiation during safety. At low levels of IU, PD was not associated with startle potentiation during safety. IU did not moderate the effect of PD on threat responding. These results suggest that PD patients with high levels of IU fail to inhibit aversive responding during safety, possibly due to a tendency to interpret distal threat as distressing.
doi:10.1016/j.janxdis.2014.06.004
PMCID: PMC4160405  PMID: 25173980
panic disorder; uncertainty; safety signals; startle
17.  The Impact of Symptom Dimensions on Outcome for Exposure and Ritual Prevention Therapy in Obsessive-Compulsive Disorder 
Journal of anxiety disorders  2014;28(6):553-558.
Objective
Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. The behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP). This study examined the impact of symptom dimensions on EX/RP outcomes in OCD patients.
Method
The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to determine primary symptoms for each participant. An exploratory factor analysis (EFA) of 238 patients identified five dimensions: contamination/cleaning, doubts about harm/checking, hoarding, symmetry/ordering, and unacceptable/taboo thoughts (including religious/moral and somatic obsessions among others). A linear regression was conducted on those who had received EX/RP (n = 87) to examine whether scores on the five symptom dimensions predicted post-treatment Y-BOCS scores, accounting for pre-treatment Y-BOCS scores.
Results
The average reduction in Y-BOCS score was 43.0%, however the regression indicated that unacceptable/taboo thoughts (β = .27, p = .02) and hoarding dimensions (β = .23, p = .04) were associated with significantly poorer EX/RP treatment outcomes. Specifically, patients endorsing religious/moral obsessions, somatic concerns, and hoarding obsessions showed significantly smaller reductions in Y-BOCS severity scores.
Conclusions
EX/RP was effective for all symptom dimensions, however it was less effective for unacceptable/taboo thoughts and hoarding than for other dimensions. Clinical implications and directions for research are discussed.
doi:10.1016/j.janxdis.2014.06.001
PMCID: PMC4151097  PMID: 24983796
obsessive-compulsive disorder; factor analysis; symptom dimensions; exposure and response prevention; hoarding; treatment outcome
18.  Implicit Associations in Social Anxiety Disorder: The Effects of Comorbid Depression 
Journal of anxiety disorders  2014;28(6):537-546.
Implicit associations of the self to concepts like “calm” have been shown to be weaker in persons with social anxiety than in non-anxious healthy controls. However, other implicit self associations, such as those to acceptance or rejection, have been less studied in social anxiety, and none of this work has been conducted with clinical samples. Furthermore, the importance of depression in these relationships has not been well investigated. We addressed these issues by administering two Implicit Association Tests (IATs; Greenwald, McGhee, & Schwartz, 1998), one examining the implicit association of self/other to anxiety/calmness and the other examining the association of self/other to rejection/acceptance, to individuals with generalized social anxiety disorder (SAD, n = 85), individuals with generalized SAD and a current or past diagnosis of major depressive disorder or current dysthymic disorder (n = 47), and non-anxious, non-depressed healthy controls (n = 44). The SAD and SAD-depression groups showed weaker implicit self-calmness associations than healthy controls, with the comorbid group showing the weakest self-calmness associations. The SAD-depression group showed the weakest implicit self-acceptance associations; no difference was found between non-depressed individuals with SAD and healthy controls. Post hoc analyses revealed that differences appeared to be driven by those with current depression. The SAD-only and SAD-depression groups did not differ in self-reported (explicit) social anxiety. The implications of these findings for the understanding of SAD-depression comorbidity and for the treatment of SAD are considered.
doi:10.1016/j.janxdis.2014.05.008
PMCID: PMC4134987  PMID: 24983794
Social anxiety disorder; social phobia; depression; implicit associations; cognitive biases
19.  Intermittent explosive disorder: Associations with PTSD and other Axis I disorders in a US Military veteran sample 
Journal of anxiety disorders  2014;28(5):488-494.
This study examined the prevalence of intermittent explosive disorder (IED) and its associations with trauma exposure, posttraumatic stress disorder (PTSD), and other psychiatric diagnoses in a sample of trauma-exposed veterans (n = 232) with a high prevalence of PTSD. Structural associations between IED and latent dimensions of internalizing and externalizing psychopathology were also modeled to examine the location of IED within this influential structure. Twenty-four percent of the sample met criteria for a lifetime IED diagnosis and those with the diagnosis were more likely to meet criteria for lifetime PTSD than those without (30.3% vs. 14.3% respectively). Furthermore, regression analyses revealed lifetime PTSD severity to be a significant predictor of IED severity after controlling for combat, trauma exposure, and age. Finally, confirmatory factor analysis revealed significant cross-loadings of IED on both the externalizing and distress dimensions of psychopathology, suggesting that the association between IED and other psychiatric disorders may reflect underlying tendencies towards impulsivity and aggression and generalized distress and negative emotionality, respectively.
doi:10.1016/j.janxdis.2014.05.001
PMCID: PMC4378832  PMID: 24907536
20.  Stereotype confirmation concern and fear of negative evaluation among African Americans and Caucasians with Social Anxiety Disorder 
Journal of anxiety disorders  2014;28(4):390-393.
Fear of negative evaluation is a central component of social anxiety. The current study examines the relation between fear of negative evaluation and fears of confirming stereotypes about a social group to which one belongs among people diagnosed with social anxiety disorder. Participants (N = 94) with a primary diagnosis of social anxiety disorder who self-identified as either African American (n = 41) or Caucasian (n = 53) completed standardized self-report measures of stereotype confirmation concerns and fear of negative evaluation. Results from hierarchical logistical regression showed that stereotype confirmation concerns predicted fear of negative evaluation for both racial groups, with greater concern predicting greater fear. This association was moderated by race, B = −.24, t = −2.67, p < .01, such that stereotype confirmation concerns had a stronger association with fear of negative evaluation for Caucasians (b = .38, p < .01) than for African Americans (b = .14, p < .05). This study is the first to directly examine the relation between stereotypes and fear of negative evaluation within a socially anxious sample. Although we cannot identify the specific social group to which each participant’s stereotype confirmation concerns apply, this study provides quantitative evidence that the social context within which socially anxious individuals view themselves impacts their fear of negative evaluation and highlights the need for further research in this area.
doi:10.1016/j.janxdis.2014.03.003
PMCID: PMC4038004  PMID: 24746163
Social Anxiety; Stereotypes
21.  Adaptive and maladaptive emotion regulation strategies: Interactive effects during CBT for social anxiety disorder 
Journal of anxiety disorders  2014;28(4):382-389.
There has been a increasing interest in understanding emotion regulation deficits in social anxiety disorder (SAD; e.g., Hofmann, Sawyer, Fang, & Asnaani, 2012). However, much remains to be understood about the patterns of associations among regulation strategies in the repertoire. Doing so is important in light of the growing recognition that people’s ability to flexibly implement strategies is associated with better mental health (e.g., Kashdan et al., 2014). Based on previous work (Aldao & Nolen-Hoeksema, 2012), we examined whether putatively adaptive and maladaptive emotion regulation strategies interacted with each other in the prediction of social anxiety symptoms in a sample of 71 participants undergoing CBT for SAD. We found that strategies interacted with each other and that this interaction was qualified by a three-way interaction with a contextual factor, namely treatment study phase. Consequently, these findings underscore the importance of modeling contextual factors when seeking to understand emotion regulation deficits in SAD.
doi:10.1016/j.janxdis.2014.03.005
PMCID: PMC4089517  PMID: 24742755
Emotion regulation; Adaptive regulation strategies; Maladaptive regulation strategies; Social anxiety; Cognitive behavioral therapy
22.  Partner Accommodation in Posttraumatic Stress Disorder: Initial Testing of the Significant Others' Responses to Trauma Scale (SORTS) 
Journal of anxiety disorders  2014;28(4):372-381.
Posttraumatic stress disorder (PTSD) is associated with myriad relationship problems and psychological distress in partners of individuals with PTSD. This study sought to develop a self-report measure of partner accommodation to PTSD (i.e., ways in which partners alter their behavior in response to patient PTSD symptoms), the Significant Others' Responses to Trauma Scale (SORTS), and to investigate its reliability and construct validity in 46 treatment-seeking couples. The SORTS demonstrated strong internal consistency and associations with individual and relationship distress. Accommodation was positively correlated with partners' ratings of patients' PTSD symptoms, patient self-reported depressive and trait anger severity, and partner self-reported depressive and state anger severity. Accommodation was negatively correlated with patient and partner relationship satisfaction and partners' perceived social support received from patients. Findings suggest that accommodation may be an attempt to adapt to living with a partner with PTSD but may have negative implications for patient and partner well-being.
doi:10.1016/j.janxdis.2014.04.001
PMCID: PMC4339021  PMID: 24816277
accommodation; partner; couples; PTSD; SORTS
23.  Predictors of PTSD Symptoms in Adults Admitted to a Level I Trauma Center: A Prospective Analysis 
Journal of anxiety disorders  2014;28(3):301-309.
Trauma centers are an ideal point of intervention in efforts to prevent posttraumatic stress disorder (PTSD). In order to assist in the development of prevention efforts, this study sought to identify early predictors of PTSD symptoms among adults admitted to a Level I trauma center using a novel analytic strategy (Fournier et al., 2009). Upon admission, participants (N=327) were screened for PTSD symptoms and provided information on potential predictor variables. Their PTSD symptoms were assessed again three months later (N=227). Participants were classified as: symptomatic (positive PTSD screen) or asymptomatic (negative PTSD screen) at the follow-up assessment. Multinomial logistic regression showed that, age, depression, number of premorbid psychiatric disorders, gunshot wound, auto vs. pedestrian accident, and alcohol use predicted who had PTSD symptoms at FU with 76.3% accuracy. However, when controlling for PTSD severity at baseline, only age, number of premorbid psychiatric disorders, and gunshot wounds predicted PTSD symptoms at FU but with 78.5% accuracy. These findings suggest that psychological prevention efforts in trauma centers may be best directed toward adults who are young, have premorbid psychiatric disorders, and those admitted with gunshot wounds.
doi:10.1016/j.janxdis.2014.01.003
PMCID: PMC4004712  PMID: 24632075
PTSD; Trauma; Predictors; Injury; Logistic Regression
24.  An Investigation of the Psychometric Properties of the Social Thoughts and Beliefs Scale (STABS) and Structure of Cognitive Symptomsin Participants with Social Anxiety Disorder and Healthy Controls 
Journal of anxiety disorders  2014;28(3):283-290.
Despite the recent increase of measures developed to assess the cognitive symptoms of social anxiety disorder (SOC), their validation is still largely preliminary. Thus, the present studies sought to replicate and extend the psychometric evaluation of the Social Thoughts and Beliefs Scale (STABS). Study 1 involved both participants with SOC (n = 206) and healthy controls (n = 222) that completed the STABS and other related measures of anxiety. In Study 2, participants with SOC (n = 66) completed exposure-based psychotherapy for SOC with the STABS used to track symptom changes. Together, the two studies provided additional support for the validity and reliability of the STABS as a measure of the cognitive symptoms of SOC. However, contrary to previous research with two subscales, a single total scale was suggested as the best interpretation of the STABS, as well as the possible general presentation of the cognitive symptoms of SOC.
doi:10.1016/j.janxdis.2014.01.004
PMCID: PMC4026922  PMID: 24607834
Social Thoughts and Beliefs Scale; STABS; social phobia; social anxiety disorder; cognitive; validity; reliability
25.  Disparities in Psychosocial Functioning in a Diverse Sample of Adults with Anxiety Disorders 
Journal of anxiety disorders  2014;28(3):335-343.
Anxiety disorders are associated with psychosocial functional impairments, but no study has compared how these impairments might vary by ethno-racial status. We examined whether minority status was uniquely associated with functional impairments in 431 adults with anxiety disorders. Functioning was measured in the rater-assessed domains of: global assessment of functioning (GAF); global psychosocial functioning; work, relationship, and recreational functioning; and, self-reported: life satisfaction, mental health functioning, physical functioning, and disability status. After controlling for demographic and clinical variables, results revealed evidence of disparities, whereby African Americans (AAs), particularly those with low income, had worse GAF, worse global psychosocial functioning, and were more likely to be disabled compared to non-Latino Whites. Latinos, particularly those with low income, had worse global psychosocial functioning than non-Latino Whites. Results suggest AAs and Latinos are at increased risk for functional impairments not better accounted for by other demographic or clinical variables.
doi:10.1016/j.janxdis.2014.02.002
PMCID: PMC4028956  PMID: 24685821
Anxiety Disorders; Psychosocial Functioning; Minorities; Risk Factors

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