Putting the client in control: The perception of control in the behavioral treatment of anxiety

Trait anxiety predicts outcome 6 weeks after cholecystectomy. A prospective follow-up study

Background

A substantial group of patients with gallstone disease experience negative outcome after surgical removal of the gallbladder (cholecystectomy). Early identification of these patients is important.

Purpose

The aim of the study is to identify predictors (clinical symptoms and trait anxiety) of negative symptomatic outcomes at 6 weeks after cholecystectomy.

Methods

Consecutive patients (n = 133), 18–65 years, with symptomatic gallstone disease, completed symptom checklists and the state-trait anxiety inventory preoperatively and at 6 weeks after cholecystectomy.

Results

High trait anxiety was the only predictor of persistence of biliary symptoms at 6 weeks after cholecystectomy (OR = 6.88).

Conclusion

In addition to clinical symptoms, high trait anxiety is a predictor of negative symptomatic outcome at 6 weeks after cholecystectomy. Trait anxiety should be evaluated to aim at a patient-tailored approach in gallstone disease.

A review of psychological factors/processes affecting anxious responding during voluntary hyperventilation and inhalations of carbon dioxide-enriched air

Despite advances in our understanding of the nature of anxiety-related responding during periods of elevated bodily arousal, it is not necessarily evident by what psychological mechanisms anxiety is produced and maintained. To address this issue, researchers have increasingly employed biological challenge procedures to examine how psychological factors affect anxious responding during elevated bodily arousal. Of the challenging procedures, hyperventilation and inhalations of carbon dioxide-enriched air have been among the most frequently employed, and a relatively large body of literature using these procedures has now accumulated. Unfortunately, existing reviews do not comprehensively examine findings from hyperventilation and inhalations of carbon dioxide studies, and only rarely the methodological issues specific to these studies. To address these issues, we review the voluntary hyperventilation and carbon dioxide-enriched air literature in order to identify the primary methodological issues/limitations of this research and address the extent to which psychological variables influence anxious responding to such challenges. Overall, we conclude challenge research is a promising paradigm to examine the influence of psychological variables in anxious responding, and that such work will likely be enhanced with greater attention to psychological process issues.

Prediction and control: operational definitions for the experimental analysis of anxiety

Prediction and/or control of threatening events generally results in less pronounced anxiety-related responding compared to when those same events are unpredictable or uncontrollable. For this reason, researchers have suggested that predictability and controllability may modulate anxiety-related responding, thereby serving an important role in the development and progression of anxiety pathology. Despite the recognized importance of prediction and control for anxiety, these variables have not been defined or operationalized in a uniform and unambiguous manner. In this article, we propose an operational definition that defines and distinguishes prediction and control in terms of the onset and offset of an aversive event. This operationalization is aimed at facilitating experimental-based efforts to explore the independent and interactive effects of the prediction and control on anxious responding.