Thought suppression: specificity in agoraphobia versus broad impairment in social phobia?

The paradoxical effects of intended thought suppression have been linked to psychological disorders, specifically anxiety disorders. So far, the evidence for thought suppression playing a major role in the disorder is mixed. One important issue is whether thought suppression is impaired only for thoughts related to the disorder, or if the ability for mental control is generally impaired in anxiety patients. This study compared groups of agoraphobics and social phobics with a healthy control group. All subjects were asked to suppress two topics related to the respective central fear of the two disorders and one nonspecific topic. We found a rather specific deficit in thought suppression for the agoraphobics; that is, when compared with the control group, we found the biggest differences for the agoraphobic fear. The social phobics seem to be characterized by a general impairment of mental control, affecting specific and nonspecific stimuli. In addition, among several psychopathological variables, social anxiety proved to be the strongest predictor for problems with thought suppression. Taken together, there are several indicators that generally impaired thought suppression may be an important feature of social phobia.

Anxious and depressive symptoms in adolescents: epidemiological data of a large scale study in Dresden

OBJECTIVES

The present large scale epidemiological study was designed to assess the prevalence of mental disorders in adolescents.

METHODS

Two cross-sectional studies have been performed in adolescents in Dresden and the results of the examination of 627 high school and 485 secondary school students (mean age 15.5 years) are presented. Self rating procedures like the Beck Depression inventory (BDI) and clinical interviews have been used to enhance validity.

RESULTS

The results underline the high prevalence rates of anxiety and depression in adolescents. Up to 30% of the 9th and 10th grades students suffer from mental disorders or are at risk for the development of mental disorders.

CONCLUSIONS

Therefore primary prevention of mental disorders is desirable.

The emotional Stroop effect in anxiety disorders: general emotional or disorder specificity?

Selective attentional biases, often documented with a modified Stroop task, are considered to play an important role in the etiology and maintenance of anxiety. Two competing explanations for these effects are selectivity for highly emotional words in general vs. selectivity for disorder-specific words. We tested these explanations in 32 patients with generalized anxiety disorder (GAD), 29 patients with social phobia (SP), and 31 non-anxious controls. Stimuli were of four kinds: GAD-related words, SP-related words, words with a neutral valence, and words with a positive valence. Different attentional biases were observed: GAD patients were slowed by all types of emotional words, while SP patients were distracted specifically by speech-related words.

Obesity and mental illness in a representative sample of young women

OBJECTIVE

To investigate the relation between mental disorders and weight, especially obesity.

DESIGN

Epidemiological study of mental disorders with a representative sample of young women.

SUBJECTS

A total of 2064 women, age 18-25 y, living in Dresden, Germany.

MEASUREMENTS

Verbal reports of body mass index, structured clinical interview for psychological disorders.

RESULTS

We found an association between psychological disorders and weight. Obese women had the highest rate of mental disorders overall, and they had higher rates of all subgroups of mental disorders, although many differences were not statistically significant. Most importantly, obese women suffered from an anxiety disorder significantly more often than women who were not obese. The observed differences were independent of socioeconomic status.

CONCLUSIONS

In young women, obesity is related to increased rates of mental disorders, most notably anxiety disorders. Future longitudinal research will have to determine the causal relationships behind this correlation.

[Anxiety and depression in students. A study in Dresden middle schools and high schools]

OBJECTIVES

Recent investigations by the WHO have shown once again the high prevalence of mental disorders in European countries. Mainly in the field of mental disorders considerable deficits exist particularly with regard to primary prevention.

METHODS

Although there is no doubt as to the importance of primary prevention within the scope of Public Health, there are deficits in this branch in Germany. This is unfortunate, considering that the proof of successful interventions is evidence for causal risk models. The current investigation is part of a study focusing upon the development, implementation and evaluation of a prevention program for anxiety and depression in adolescents and young adults.

RESULTS

Presented here are the prevalence rates of anxiety disorders and depression ascertained in the first cross-sectional study carried out in secondary schools and high schools. A total of 627 high school students and 485 secondary school students in grades nine and ten in Dresden were examined.

Angst und Depression bei Schülern

Zusammenfassung Fragestellung: Neueste Untersuchungen der WHO haben europaweit erneut Belege für die hohe Prävalenz psychischer Erkrankungen erbracht. Vor allem bei psychischen Störungen bestehen erhebliche Defizite im Bereich der primären Prävention.Methodik: Obwohl Einigkeit darüber besteht, dass der primären Prävention im Rahmen der Public Health ganz besondere Bedeutung zukommt, ist dieser Forschungszweig in Deutschland bisher defizitär. Dies ist umso bedauerlicher, als gerade der Nachweis erfolgreicher Interventionen einen Beweis für kausale Risikomodelle liefert. Die hier vorgestellte Untersuchung ist Teil einer Studie, deren Hauptziel die Entwicklung, Implementation und Evaluation eines Programms zur Prävention von Depressionen und Angststörungen bei Jugendlichen und jungen Erwachsenen ist.Ergebnisse: Die vorliegende Arbeit präsentiert die im Rahmen der ersten Querschnittstudie an Gymnasien und Mittelschulen in Dresden ermittelten Prävalenzraten für Angststörungen und Depressionen. Insgesamt wurden 627 Gymnasiasten und 485 Mittelschüler der Klassenstufen 9 und 10 in Dresden untersucht.

[Are eight-year olds already suffering from panic disorder? Investigation of prevalence with focus on panic disorder and agoraphobia]

A representative sample of 826 eight-year-old second-graders in Dresden was examined in a two-stage procedure to ascertain the 6-month prevalence of DSM-IV anxiety disorders. Particular care was taken to assess panic disorder. The eight-year-olds had already been interviewed personally in a screening session and in 230 children an individual diagnostic examination with a structured diagnostic interview was carried out. The total prevalence of anxiety disorder was 9.5%. No case of either panic disorder or agoraphobia was found. For the diagnosis of agoraphobia the DSM-IV diagnostic criterion was lacking in which situations typical to agoraphobia are feared or avoided because escape would be difficult or it would be difficult to reach help. Eight-year-olds do not forge this cognitive link. In agoraphobic situations 2.5% of the children (almost exclusively, girls) suffer from a specific phobia. The prevalence of anxiety disorders is markedly higher among girls than in boys.

[Are eight-year olds already suffering from panic disorder? Investigation of prevalence with focus on panic disorder and agoraphobia]

A representative sample of 826 eight-year-old second-graders in Dresden was examined in a two-stage procedure to ascertain the 6-month prevalence of DSM-IV anxiety disorders. Particular care was taken to assess panic disorder. The eight-year-olds had already been interviewed personally in a screening session and in 230 children an individual diagnostic examination with a structured diagnostic interview was carried out. The total prevalence of anxiety disorder was 9.5%. No case of either panic disorder or agoraphobia was found. For the diagnosis of agoraphobia the DSM-IV diagnostic criterion was lacking in which situations typical to agoraphobia are feared or avoided because escape would be difficult or it would be difficult to reach help. Eight-year-olds do not forge this cognitive link. In agoraphobic situations 2.5% of the children (almost exclusively, girls) suffer from a specific phobia. The prevalence of anxiety disorders is markedly higher among girls than in boys.

[Separation anxiety and agoraphobia in 8-year-old children]

In the literature on the aetiology of panic disorder, the separation-anxiety-hypothesis is discussed, in which separation anxiety disorder is conceived as a precursor of panic disorder. Using the representative sample of the Dresden Child Anxiety Study (DKAS) we examined weather agoraphobic and separation anxiety symptoms do already co-occur systematically in eight-year-olds. After N = 826 children had been screened, N = 230 took part in an individual diagnostic interview. With a total prevalence of 9.5% for all anxiety disorders, the prevalence rate for separation anxiety amounted to 2.8%. Another 2.5% of the children (almost exclusively girls) received a diagnosis of specific phobia in agoraphobic situations. Separation anxiety, social anxiety, agoraphobic anxiety and panic anxiety were assessed on a dimensional level, as well. However, no specific pattern of co-morbidity could be found in terms of an increased frequency of agoraphobic fears and separation anxiety occurring simultaneously. The symptom profiles of children with separation anxiety and those with agoraphobic anxieties differed considerably. Children currently living in a separation situation do not exhibit separation anxiety or agoraphobia more frequently than the rest of the children.

Explicit memory in anxiety disorders

Two experiments were conducted to study selective memory bias favoring anxiety-relevant materials in patients with anxiety disorders. In the 1st experiment, 32 patients with generalized anxiety disorder (GAD), 30 with social phobia (speaking anxiety), and 31 control participants incidentally learned GAD-relevant words, speech anxiety-relevant words, strongly pleasant words, and words with a neutral valence. Participants did not show any explicit memory bias for threatening materials. Thirty patients suffering from panic disorder (PD) with agoraphobia and 30 controls took part in the 2nd experiment. The design was similar to the 1st experiment. This time a highly specific selective memory bias for threatening words was found. Words describing symptoms of anxiety were better recalled by PD patients. Results are consistent with previous findings but are inexplicable by existing theories.

Explicit memory in anxiety disorders

Two experiments were conducted to study selective memory bias favoring anxiety-relevant materials in patients with anxiety disorders. In the 1st experiment, 32 patients with generalized anxiety disorder (GAD), 30 with social phobia (speaking anxiety), and 31 control participants incidentally learned GAD-relevant words, speech anxiety-relevant words, strongly pleasant words, and words with a neutral valence. Participants did not show any explicit memory bias for threatening materials. Thirty patients suffering from panic disorder (PD) with agoraphobia and 30 controls took part in the 2nd experiment. The design was similar to the 1st experiment. This time a highly specific selective memory bias for threatening words was found. Words describing symptoms of anxiety were better recalled by PD patients. Results are consistent with previous findings but are inexplicable by existing theories.

Cognitive aspects of hypochondriasis and the somatization syndrome

The aim of this study was to evaluate whether specific cognitive aspects are present in patients suffering from somatoform disorders. With a sample of 493 patients from a center for behavioral medicine, the authors evaluated a questionnaire assessing typical cognitions concerning body perception, illness behavior, and health. The authors further examined 225 participants, including patients with a somatization syndrome, patients with somatization syndrome and additional hypochondriasis, patients with hypochondriasis, patients with other mental disorders (clinical control group), and nonclinical controls. The results showed that not only patients with hypochondriasis but also patients with somatization syndrome had cognitive concerns and assumptions that were specific for the disorder. These patients had a self-concept of being weak and unable to tolerate stress. A catastrophizing interpretation of minor bodily complaints found in hypochondriacal patients in earlier studies was also found for patients with multiple somatization symptoms.

Cognitive aspects of hypochondriasis and the somatization syndrome

The aim of this study was to evaluate whether specific cognitive aspects are present in patients suffering from somatoform disorders. With a sample of 493 patients from a center for behavioral medicine, the authors evaluated a questionnaire assessing typical cognitions concerning body perception, illness behavior, and health. The authors further examined 225 participants, including patients with a somatization syndrome, patients with somatization syndrome and additional hypochondriasis, patients with hypochondriasis, patients with other mental disorders (clinical control group), and nonclinical controls. The results showed that not only patients with hypochondriasis but also patients with somatization syndrome had cognitive concerns and assumptions that were specific for the disorder. These patients had a self-concept of being weak and unable to tolerate stress. A catastrophizing interpretation of minor bodily complaints found in hypochondriacal patients in earlier studies was also found for patients with multiple somatization symptoms.

Don't worry and beware of white bears: thought suppression in anxiety patients

The ability to suppress unwanted thoughts was investigated in patients with Generalized Anxiety Disorder (GAD; n = 29), Speech Phobics (n = 25), and nonanxious controls (n = 28). All participants spent 5 minutes thinking aloud about anything that came to mind while trying not to think of white bears. In another task, they thought aloud for 5 minutes while trying not to think of their main worry. Intrusions of unwanted thoughts were signaled by button presses and recorded on tape. In accordance with the disorder's definition and complaints of the GAD patients, they showed more intrusions of their main worry than of white bears. The opposite was true for other participants. Compared to a baseline measure, all participant groups were unable to reduce duration of main worry thoughts when trying to suppress them.

Psychopathology in children of patients with panic disorder or animal phobia

Several studies reveal a heightened risk for anxiety and other mental disorders in the offspring of patients with panic disorder and other anxiety disorders. Data on the specific type of transmitted disorders, however, are inconsistent. We investigated the specificity of the relationship between parents' and children's psychopathology. We assessed current and past mental disorders in 5- to 15-year-old children of patients with panic disorder (CPAN, n = 34), children of parents with no diagnosis of a mental disorder (CCON, n = 30) and children of animal phobics (CPHOB, n = 23) using a structured diagnostic interview according to DSM-III-R criteria. Diagnoses are based on parent as well as child information. CPAN and CPHOB had significantly more often at least one current mental disorder than children of the healthy control parents. Compared to CPHOB and CCON, children of panic patients had significantly more severe diagnoses and more often multiple diagnoses. Furthermore, a higher rate of internalizing anxiety disorders, particularly separation anxiety disorder, was found in CPAN. In contrast, children of animal phobics showed a higher rate of externalizing anxiety disorders. Our results suggest a specific transmission of such disorders that share common features of parental symptomatology.

[Panic disorder and its psychological treatment]

Over the past decade, panic disorder has become a major research focus in psychopathology and treatment. Initial interest in the causes of the disorder was triggered by biological theories and investigators. More recently, however, research on newly developed psychological approaches has advanced our understanding of panic disorder and has led to the development of specific treatment programs. This review describes symptomatology and course, the psychophysiological model of panic and a psychological treatment that directly targets panic attacks and the fears and behaviors associated with them.