Seeking the source of emotional Stroop interference effects in PTSD: a study of P3s to traumatic words

We investigated the source of emotional Stroop interference effects in posttraumatic stress disorder (PTSD) by measuring reaction times and P3 latencies and amplitudes to personal traumatic, personal positive, and neutral words in a modified Stroop paradigm. Individuals with PTSD were slower to indicate word color, especially for traumatic words, thereby replicating emotional Stroop interference in PTSD. Individuals with PTSD also had significantly reduced and delayed P3 components across word types. Across diagnostic groups, frontal P3 amplitudes were larger to personal positive and traumatic words compared to standard neutral words. However, the absence of Diagnosis x Word Type interactions for P3 measures suggests that individuals with PTSD do not differ from individuals without PTSD in the encoding and recognition of the color of traumatic relative to nontraumatic words, and that Stroop interference does not occur during these early stages of processing.

Suppression of the emotional Stroop effect by increased anxiety in patients with social phobia

Anxious individuals are slower at color-naming threat-related than nonthreat-related words in the emotional Stroop task. Recently, Mathews and Sebastian (1993, Cognition and Emotion, 7, 527-530) reported that this Stroop interference effect disappears when snake-fearful students are exposed to a snake while performing the color-naming task. In the present experiment, we had patients with social phobia and normal control subjects perform an emotional Stroop task under either low anxiety (i.e. upon entering the laboratory) or high anxiety (i.e. before giving a speech). Results indicated that Stroop interference for socially threatening words in the phobic group was suppressed under high anxiety. These findings may indicate that increased effort enables the subjects to suppress the interference produced in the Stroop task.

Anxiety sensitivity, suffocation fear, and breath-holding duration as predictors of response to carbon dioxide challenge

Predictors of response to carbon dioxide challenge (i.e., breathing deeply and rapidly into a paper bag for 5 min) were evaluated in 78 college students. Zero-order correlations revealed that scores on the Suffocation Fear Scale (SFS; S. Rachman & S. Taylor, 1994) and the Anxiety Sensitivity Index (S. Reiss, R. A. Peterson, D. M. Gursky, & R. J. McNally, 1986) predicted anxiety and self-reported bodily sensations, whereas a behavioral measure of carbon dioxide sensitivity (i.e., maximum breath-holding duration) did not. Multiple regression analyses revealed that the SFS was the only significant predictor of anxiety and bodily sensations. Just as anxiety sensitivity is a better predictor than trait anxiety of the response to biological challenges in general, suffocation fear is a better predictor than anxiety sensitivity for challenges that increase carbon dioxide.

Directed forgetting in obsessive-compulsive disorder

We tested whether patients with obsessive-compulsive disorder (OCD) are characterized by dysfunction in the ability to forget disturbing material. Employing a directed forgetting procedure, we presented OCD patients and healthy control subjects with a series of negative, positive, and neutral words, and instructed them either to remember or to forget each item after it was presented. Subjects received free recall and recognition tests for all words, regardless of instructions. Orthogonal planned contrasts indicated that OCD patients exhibited deficits in the ability to forget negative material relative to positive and neutral material, whereas control subjects did not. Additional analyses suggested that OCD patients elaboratively encoded negative words, regardless of instructions, thereby enhancing their memorability.

Anxiety sensitivity, suffocation fear, trait anxiety, and breath-holding duration as predictors of response to carbon dioxide challenge

We investigated predictors of response to carbon dioxide challenge (i.e. breathing deeply and rapidly into a paper bag for 5 min) in college students. Zero-order correlations indicated that scores on both the Anxiety Sensitivity Index (ASI: Reiss, Peterson, Gursky & McNally, 1986) and the Suffocation Fear Scale (SFS: Rachman & Taylor, 1994), predicted anxious response to challenge, whereas a behavioral measure of carbon dioxide sensitivity (i.e. maximum breath-holding duration) and scores on the State-Trait Anxiety Inventory--Trait form (STAI-T: Spielberger, Gorsuch, Lushene, Vagg & Jacobs, 1983) did not. Multiple regression revealed that all four variables remained in the model, entering in the following order: ASI, breath-holding duration, SFS, and STAI-T. These data suggest that psychological variables reflecting fears of bodily sensations are better predictors of response to challenge than either behavioral sensitivity to carbon dioxide or general trait anxiety.

Neural effects of visualizing and perceiving aversive stimuli: a PET investigation

Cerebral blood flow was recorded (using positron emission tomography) while middle-aged subjects viewed or visualized pictures of neutral or aversive stimuli, and then determined whether auditorily presented statements correctly described the stimuli. Visualizing aversive stimuli enhanced cerebral blood flow, relative to visualizing neutral stimuli, in areas 17 (right) and 18 (bilateral), as well as the anterior insula (bilateral) and middle frontal cortex (left). Areas 17 and 18 have been identified as supporting the representations that underlie the experience of imagery, and the anterior insula is a major cortical recipient of input from the autonomic nervous system. Perceiving aversive stimuli enhanced cerebral blood flow, relative to neutral stimuli, in area 46, the angular gyrus and area 19, area 47, and the middle temporal gyrus (all in the left hemisphere). All of these areas have previously been implicated in visual object identification. It is striking that negative emotion did not modulate activation in any areas in the same way during imagery and perception.

The incidence and distribution of leukaemia and lymphoma within Northern Ireland in the period 1989-1993

This is the first attempt to systematically record haematological malignancies in Northern Ireland. The methods are identical to a similar effort in other parts of the UK, except that an independent cross check with a cancer registry source was not possible. In addition problems with the census may create differences. Generally, the rates for the leukaemias are slightly lower than in England and Wales, except for acute lymphoblastic leukaemia whilst non-Hodgkin's lymphoma rates are higher. It remains to be seen how stable this situation is as further data are accumulated.

Validation of the spanish version of the Anxiety Sensitivity Index in a clinical sample

In this study we validated the Spanish version of the Anxiety Sensitivity Index (ASI) in a sample of anxiety disordered patients. The results revealed that: (1) ASI scores were higher for anxiety disordered patients than for normal control subjects, and higher for patients with panic disorder (PD) than for patients with other anxiety disorders (OAD). In contrast, there were no differences among the groups on the Cognitive-Somatic Anxiety Questionnaire (CSAQ). (2) Using discriminant analysis, we were able to differentiate PD patients from patients with OAD on the ASI, but not on the CSAQ. (3) Results supported a unidimensional factor-structure for the ASI. (4) Data provide cross-cultural evidence for construct validity and concurrent validity of the Spanish ASI, and provide further evidence for the usefulness of the concept of anxiety sensitivity.

Methodological controversies in the treatment of panic disorder

Although the National Institutes of Health Consensus Development Conference on the Treatment of Panic Disorder endorsed the effectiveness of cognitive-behavior therapy (CBT), D. F. Klein (1996) argues that fatal flaws in all but one (negative) CBT study undermine claims about the effectiveness of CBT for panic disorder. He holds that methodologically sound CBT trials must include a drug condition and a pill placebo condition and must demonstrate the superiority of drug versus placebo; otherwise researchers are debarred from making comparative statements about the effectiveness of CBT versus drug (or placebo). The purpose of the present article is to provide a critique of Klein's arguments and to provide suggestions for resolving methodological disputes in the panic disorder field.

Anxiety sensitivity, suffocation fear, and breath-holding duration as predictors of response to carbon dioxide challenge

Predictors of response to carbon dioxide challenge (i.e., breathing deeply and rapidly into a paper bag for 5 min) were evaluated in 78 college students. Zero-order correlations revealed that scores on the Suffocation Fear Scale (SFS; S. Rachman & S. Taylor, 1994) and the Anxiety Sensitivity Index (S. Reiss, R. A. Peterson, D. M. Gursky, & R. J. McNally, 1986) predicted anxiety and self-reported bodily sensations, whereas a behavioral measure of carbon dioxide sensitivity (i.e., maximum breath-holding duration) did not. Multiple regression analyses revealed that the SFS was the only significant predictor of anxiety and bodily sensations. Just as anxiety sensitivity is a better predictor than trait anxiety of the response to biological challenges in general, suffocation fear is a better predictor than anxiety sensitivity for challenges that increase carbon dioxide.

Trichotillomania and self-esteem: a survey of 62 female hair pullers

BACKGROUND

The psychological features of trichotillomania have received little empirical attention, despite the fact that sufferers commonly report negative self-image to be one of the most disturbing aspects of the disorder. We conducted the current study to identify specific factors that predict self-esteem problems in hair pullers.

METHOD

Sixty-two women with trichotillomania or repetitive hair pulling completed self-report forms assessing factors possibly related to self-esteem in hair pullers. The survey included questions related to demographics, hair-pulling symptoms, mood and anxiety symptoms, and body image concerns.

RESULTS

Self-esteem did not appear to be directly related to age at onset of hair pulling or severity of hair loss. However, self-esteem was related to level of depression, frequency of hair pulling, level of anxiety, and body dissatisfaction unrelated to hair pulling.

CONCLUSION

Several factors, including the frequency of hair pulling, are associated with low self- esteem in patients with trichotillomania. Specific efforts should be made to address these issues in treatment.

Implicit memory bias for threat in panic disorder: application of the 'white noise' paradigm

We employed Jacoby's white noise paradigm to investigate implicit memory bias for threat in panic disorder and in normal control subjects. Subjects heard a series of neutral sentences (e.g. "The shiny apple sat on the table") and panic sentences (e.g. "The anxious woman panicked in the supermarket"). Implicit memory for this prior exposure was then tested by having subjects rate the volume of white noise accompanying the presentation of 'old' sentences intermixed with 'new' sentences. Implicit memory for old sentences is revealed when subjects rate the white noise accompanying these sentences as less loud than noise accompanying new sentences. Results revealed that under low noise level, panic patients demonstrated an implicit memory bias for threat information, whereas control subjects did not. This differential priming effect suggests that information about threat may be automatically accessed in these patients.

Methodological controversies in the treatment of panic disorder

Although the National Institutes of Health Consensus Development Conference on the Treatment of Panic Disorder endorsed the effectiveness of cognitive-behavior therapy (CBT), D. F. Klein (1996) argues that fatal flaws in all but one (negative) CBT study undermine claims about the effectiveness of CBT for panic disorder. He holds that methodologically sound CBT trials must include a drug condition and a pill placebo condition and must demonstrate the superiority of drug versus placebo; otherwise researchers are debarred from making comparative statements about the effectiveness of CBT versus drug (or placebo). The purpose of the present article is to provide a critique of Klein's arguments and to provide suggestions for resolving methodological disputes in the panic disorder field.

Automaticity and the anxiety disorders

Experimental psychopathologists have increasingly relied upon the concepts and methods of cognitive psychology in their attempts to elucidate information-processing biases associated with anxiety disorders. Many of these biases presumably constitute instances of automatic, not strategic, processing. But research has shown that attributes of automaticity (i.e. capacity-free, unconsious, involuntary) do not all apply to selective processing of threat associated with anxiety. Experimental and clinical findings suggest that biases are automatic in the sense of being involuntary (and sometimes unconscious), but not in the sense of being capacity-free. Implications of involuntary automatic processing of threat for behavior therapy are discussed.

Panic disorder and suicide attempt. A reanalysis of data from the Epidemiologic Catchment Area study

BACKGROUND

Analysing data from the Epidemiologic Catchment Area (ECA) study, Weissman and colleagues reported that panic disorder was strongly associated with suicide attempt. However, they did not control optimally for comorbid disorders known to increase suicide risk.

METHOD

Reanalysing the ECA data, we controlled for comorbid disorders in the aggregate rather than one at a time when we estimated the association between panic disorder and suicide attempt.

RESULTS

Panic disorder was not associated with an increased risk of suicide attempt.

CONCLUSIONS

Comorbid conditions strongly influence whether people with panic disorder are at especial risk of suicide attempt.

Autobiographical memory disturbance in combat-related posttraumatic stress disorder

Vietnam combat veterans with (n = 19) and without (n = 13) posttraumatic stress disorder (PTSD) participated in an autobiographical memory experiment in which they attempted to retrieve specific personal memories exemplifying traits denoted by positive (e.g. loyal) and negative (e.g. guilty) cue words. Veterans with PTSD exhibited difficulties retrieving specific autobiographical memories, especially in response to positive trait cue words. These deficits were especially pronounced in PTSD Ss who wore Vietnam War regalia (e.g. medals, fatigues) to the laboratory. Regalia-wearing PTSD Ss disproportionately retrieved memories from the Vietnam War, unlike other Ss who retrieved relatively recent memories. Wearing regalia in daily life may be emblematic of psychological fixation to a war fought more than two decades ago. Difficulties remembering one's past may underlie difficulties envisioning one's future, as reflected in the PTSD symptom of 'future foreshortening', and difficulties using memory specifically may also hamper efforts to solve personal problems.

Association of intelligence with severity of posttraumatic stress disorder symptoms in Vietnam Combat veterans

OBJECTIVE

The purpose of this study was to determine whether intelligence predicts variance in posttraumatic stress disorder (PTSD) symptoms beyond that predicted by extent of combat exposure.

METHOD

The subjects were 105 male Vietnam combat veterans. They completed the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder, the Combat Exposure Scale, and the Shipley Institute for Living Scale, a measure of general intelligence. Number of years of education was recorded for each subject.

RESULTS

Multiple regression analyses revealed that estimated full-scale IQ significantly predicted variance in PTSD symptoms beyond that predicted by extent of combat exposure. The lower a subject's intelligence, the more severe were his PTSD symptoms.

CONCLUSIONS

Cognitive variables may affect the ability to cope with trauma, thereby affecting whether a person develops chronic PTSD.

Clinical versus nonclinical panic: a test of suffocation false alarm theory

Klein's suffocation false alarm theory of panic implies that suffocation sensations should distinguish clinical from nonclinical panic attacks better than should other symptoms. To test this theory, we conducted phenomenologic comparisons between attack patterns of patients with panic disorder and community subjects who had experienced unexpected panic. Effect size and multivariate analyses revealed that three cognitive symptoms best discriminated clinical from nonclinical panic (fears of dying, heart attack, and loss of control). These findings are consistent with cognitive theories of panic. Although lacking the discriminative power of cognitive symptoms, suffocation sensations had the largest effect size of any physiological symptom. Accordingly, suffocation sensations may be especially likely to give rise to the catastrophic thoughts that best discriminate clinical from nonclinical panic.

Choking phobia: a review of the literature

Choking phobia is characterized by fear and avoidance of swallowing food, fluids, or pills. Most individuals with this phobia suddenly acquire their fear after an episode of choking on food. Fear of choking appears to occur somewhat more often in females than in males, and has a variable age of onset ranging from childhood to old age. Its prevalence is unknown. Choking phobia appears responsive to antipanic medication and to certain cognitive and behavioral therapies.

Cognitive processing of idiographic emotional information in panic disorder

Panic disorder patients, obsessive-compulsive disorder (OCD) patients, and normal control subjects performed a computerized Stroop color-naming task in which they named the colors of panic-threat words (e.g. Collapse), general-threat words (e.g. Infectious), positive words related to panic (e.g. Relaxed), and neutral words (e.g. Sleepy). Idiographic stimulus selection ensured their personal emotional relevance for each subject. In accordance with prediction, panic patients, but not OCD patients, exhibited greater interference for panic-threat words than for positive words related to panic and for neutral words. Panic patients did not respond differentially to panic-threat and general-threat words. Complexities concerning attentional bias research in the anxiety disorders are discussed.

The epidemiology of diabetes mellitus in the United Kingdom: the Yorkshire Regional Childhood Diabetes Register

A register of the incidence of Type 1 (insulin-dependent) diabetes mellitus in the Yorkshire region of the United Kingdom has been completed. A total of 1,490 subjects aged between 0 and 16 years were identified from 1978 to 1990, giving an incidence of 13.7 per 100,000 (ages 0-14) or 13.6 per 100,000 (ages 0-16), comparable to other recent studies in the United Kingdom. An age-period-cohort analysis shows evidence for a modest drift effect of 1.75% per year (95% confidence interval 0.28 to 3.25%). There is a marked epidemic pattern with peaks at 4-year intervals. The age-incidence curve is similar to that reported elsewhere, having peaks in early childhood and puberty. Girls have an earlier pubertal peak than boys. There is substantial seasonal variation in incidence confined to those over 5 years of age. Ascertainment is believed to be very complete, and is estimated to be 97.6% (95% confidence interval 97.2% to 98.1%).

Anorexia nervosa in an elderly man

Anorexia nervosa (AN) rarely develops after the age of 30 years, and rarely occurs in men. We report a case of chronic AN in a 72-year-old man, who reported a 20-year history of extreme low body weight, persistent fears of obesity, and feelings of being fat even at 93 lb. Also reported were episodes of self-induced vomiting, laxative abuse, and excessive exercising. Patient's scores on a battery of questionnaires were also consistent with a diagnosis of AN.

Are covariation biases attributable to a priori expectancy biases?

Illusory correlation experiments indicate that people overestimate the association between random presentations of snake slides and shock, but do not overestimate the association between random presentations of slides of damaged and exposed electric outlets (DEEOs) and shock. To investigate whether reports of covariation biases might be attributable to expectancy biases, we had Ss rate the a priori probabilities with which they would expect slides of snakes (or DEEOs), flowers, and mushrooms to be paired with shock, a tone, or nothing. In Study 1, Ss reported a pattern of a priori slide/outcome probability estimates that is nearly identical to that reported by Ss who have just undergone an illusory correlation procedure involving phylogenetic fear-relevant stimuli (e.g. snakes). Therefore, postexperimental estimates of covariation involving such stimuli appear at least partly attributable to pre-experimental expectancy biases rather than solely attributable to on-line processing biases. Study 2 revealed that Ss also display inflated a priori probability estimates for DEEO slides and shock, unlike Ss who have just undergone an illusory correlation procedure involving such stimuli. Taken together, these studies suggest that random slide/outcome pairings easily abolish pre-experimental expectancy biases for ontogenetic, but not phylogenetic, fear-relevant stimuli.

Alexithymia in victims of sexual assault: an effect of repeated traumatization?

The authors compared scores on the Toronto Alexithymia Scale of 12 rape victims with PTSD, 12 rape victims without PTSD, and 12 nontraumatized comparison subjects. Rape victims were more alexithymic than were nontraumatized comparison subjects, and subjects with a history of more than one episode of rape were more alexithymic than were subjects with a single episode.