Efficacy of probiotic supplements in improving the symptoms of psychosis, anxiety, insomnia, and anorexia due to amphetamine and methamphetamine use: a randomized clinical trial

RATIONALE

Changes in the density and diversity of gut microbiota in chronic use of methamphetamine have been mentioned as contributors to psychotic and anxiety symptoms, sleep problems, and loss of appetite.

OBJECTIVE

In this placebo-controlled clinical trial, we investigated the effect of the probiotic Lactobacillus Acidophilus in improving psychiatric symptoms among hospitalized patients with chronic methamphetamine use along with psychotic symptoms.

METHODS

60 inpatients with a history of more than 3 years of methamphetamine use, were randomly assigned to one of two groups receiving either a probiotic capsule or placebo along with risperidone for 8 weeks based on a simple randomization method. In weeks 0, 4, and 8, patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), Simple Appetite Nutritional Questionnaire (SANQ), and Body Mass Index (BMI).

RESULTS

Compared to the control group, patients receiving probiotics had better sleep quality, greater appetite, and higher body mass index (there were significant interaction effects of group and time at Week 8 in these variables (t = -3.32, B = -1.83, p = .001, d = 0.89), (t = 10.50, B = 2.65, p <.001, d = 1.25) and (t = 3.40, B = 0.76, p <.001, d = 0.30), respectively. In terms of the improvement of psychotic and anxiety symptoms, there was no statistically significant difference between the two groups.

CONCLUSIONS

The use of probiotics was associated with improved sleep quality, increased appetite, and increased body mass index in patients with chronic methamphetamine use. Conducting more definitive clinical trials with larger sample sizes and longer-term follow-up of cases is recommended.

Efficacy of vitamins B1 and B6 as an adjunctive therapy to lithium in bipolar-I disorder: A double-blind, randomized, placebo-controlled, clinical trial

BACKGROUND

The use of adjunctive therapy for bipolar disorder is increasingly considered to increase the efficacy of standard treatments. In this randomized clinical trial, we evaluated the effect of vitamins B1 and B6 in separate treatment arms on mood symptoms, cognitive status, and sleep quality in hospitalized patients with bipolar disorder in manic episodes.

METHOD

In addition to receiving standard lithium treatment, participants (N = 66) were randomized to one of three conditions: 100 mg of vitamin B1, 40 mg of vitamin B6, or placebo. Outcomes were assessed one and 8 weeks of daily treatment, including the Young Mania Rating Scale (YMRS), Pittsburgh Sleep Quality Scale (PSQI), and Mini-Mental State Examination (MMSE). This study was performed between December 2020 and September 2021 based on the registration code number IRCT20200307046712N1.

RESULTS

Vitamin B6 had a significant effect (P value < 0.025 as significant) on mood improvement compared to placebo (F (1, 27.42) = 30.25, P < 0.001, r = 0.72), but vitamin B1 had no significant effect on mood improvement compared to Placebo (F (1/35.68) = 4.76, P = 0.036, r = 0.34). The contrasts between groups on PSQI showed a significant effect (P value < 0.025 as significant) of vitamin B6 over placebo for sleep status improvement (F (1/32.91) = 16.24, P < 0.001, r = 0.57) and also a significant effect of vitamin B1 over placebo (F (1/41.21) = 13.32, P < 0.001, r = 0.49).

CONCLUSIONS

The use of vitamin B6 as an adjunctive therapy to lithium can be associated with the improvement of mood symptoms in patients with bipolar disorder in the midst of a manic episode.

Posttraumatic stress disorder symptoms and mindfulness facets in relation to suicide risk among firefighters

OBJECTIVE

Posttraumatic stress disorder (PTSD) symptoms are associated with increased suicide risk among firefighters. Few studies have examined modifiable factors, such as mindfulness facets, that might attenuate this association. This study examined the interactive effects of PTSD symptoms and mindfulness facets in relation to suicide risk among firefighters.

METHOD

Overall, 831 career firefighters were assessed for PTSD symptoms, mindfulness facets, and suicide risk via the PTSD Checklist for DSM-5, Five Facet Mindfulness Questionnaire, and Suicidal Behaviors Questionnaire-Revised, respectively.

RESULTS

Greater PTSD symptoms were associated with more severe suicide risk; however, higher levels of two specific mindfulness facets, acting with awareness and nonjudging of inner experience, attenuated this association. By contrast, higher levels of the observing facet of mindfulness potentiated the association between PTSD symptoms and suicide risk.

CONCLUSIONS

Suicide prevention initiatives among firefighters, particularly those experiencing trauma-related sequelae, might benefit from the inclusion of mindfulness-based practices alongside frontline empirically-supported approaches.

Negative interpretations of distress-related information: A novel assessment tool for distress tolerance

Distress tolerance (DT), defined as the perceived and/or actual behavioral capacity to tolerate negative emotional states, is considered an important risk factor for various externalizing and internalizing disorders. Despite the importance of DT in the development and maintenance of psychopathology, few reliable and valid indicators of DT have been developed. One potentially useful way to assess DT is through interpretation bias (IB) paradigms. The current study sought to examine the convergent validity, reliability, and clinical utility of a DT-focused IB paradigm by directly measuring an individual's interpretations of distressing information. Participants completed a DT-IB task and self-report questionnaires. Results found an association between DTS self-report and an exaggerated DT-IB. Reliability analyses found the word pairings in our DT-IB task to display good internal consistency. In addition, an exaggerated DT-IB was associated with diagnostic status after covarying for negative affect and self-report DTS and DT-IB was associated with increased levels of negative affect above and beyond self-report DTS. This study is the first to identify specific interpretation biases for distress-related information. Given the transdiagnostic nature of DT and the efficacy and accessibility associated with CBM-I protocols for related constructs, the present findings add considerably to a growing body of literature.

The anxiety sensitivity index: item analysis and suggestions for refinement

Anxiety sensitivity is the fear of anxiety-related sensations, and is measured by the 16-item Anxiety Sensitivity Index (ASI). Despite the popularity and utility of the ASI in research, a number of studies have provided evidence for the inadequacy of several items, and item-to-scale correlations for the ASI have not been published. In this study, a converging set of analyses to evaluate the item adequacy and factor structure of the ASI was used. The results of these multiple analyses converged nicely suggesting that Items 1, 5, 7, 8, and 13 should be considered for removal from the instrument. The impact of removing these problematic items from the scale was explored through the reanalysis of data from 3 previously published studies that compared the original ASI with the new 11-item version (the ASI minus the 5 problematic items). The results of these analyses suggest that the 2 scales function comparably in many respects but that the new version may be a more precise measure of anxiety sensitivity. The 11-item ASI appears to tap 2 primary aspects of anxiety sensitivity: fears of somatic sensations of anxiety and fears of loss of mental control. Suggestions for further development of the ASI are offered.

Effects of heart-rate feedback on estimated cardiovascular fitness in patients with panic disorder

Psychological parameters that are believed to affect estimations of cardiovascular fitness were examined in patients with panic disorder and nonclinical controls. Fifty-four participants [panic disorder patients (n = 27) and age- and sex-matched nonclinical controls (n = 27)] completed a cycle ergometer test and were compared on the basis of estimated VO2 max. Participants were randomly assigned to experimental conditions in which they received heart-rate feedback or no feedback during the test. Patients with panic disorder exhibited lower VO2 max and decreased exercise tolerance (i.e., were more likely to discontinue the test) than nonclinical controls. Furthermore, individuals with high anxiety sensitivity (i.e., a fear of autonomic arousal), but not a panic disorder diagnosis per se, achieved significantly lower VO2 max when provided with heart-rate feedback. Moreover, diagnostic status interacted with levels of anxiety sensitivity to predict VO2 max. Patients with panic disorder display poorer cardiovascular fitness after controlling for anxiety and other factors that underestimate performance during fitness testing.

Evaluating panic-specific factors in the relationship between suicide and panic disorder

Work during the past decade has suggested an association between panic disorder and suicide (i.e., suicidal ideation and suicide attempts) that cannot simply be accounted for by co-occurring depression symptoms. To clarify the linkage between panic disorder and suicide, the association between panic-specific clinical and cognitive variables and suicide indicators were evaluated in patients with panic disorder (N=146). Analyses predicting the presence of suicidal ideation (positive, negative) after covarying the effects of a current mood disorder diagnosis and depression symptoms indicated a number of significant predictors including: (1) overall anxiety symptoms; (2) level of anticipatory anxiety; (3) avoidance of bodily sensations; (4) attentional vigilance toward bodily perturbations; and (5) phrenophobia (i.e., fear of cognitive incapacitation). Anxiety-specific variables did not account for unique variance in predicting prior history of suicide attempts.

Hopelessness depression as a distinct dimension of depressive symptoms among clinical and non-clinical samples

Subtyping depression has been an interest of theorists and clinicians for at least four centuries. In this paper, we examined the validity of the symptom cluster component of the hopelessness theory of depression. We used structural equation modeling analyses on large samples of psychiatric outpatients (N=1604, 844, and 680) and Air Force cadets (N=1404) who completed the items of the Beck Depression Inventory (BDI). Findings were supportive of the hopelessness depression cluster as a distinct depressive syndrome. Implications for the nosology of depression and for depression theory were discussed.

Prospective evaluation of the etiology of anxiety sensitivity: test of a scar model

A large body of research has suggested that anxiety sensitivity (AS) acts as a specific vulnerability factor in the development of anxiety pathology. More recently, attention has turned to the etiology of AS per se. The present study represents a specific test of a Scar model of AS. A Scar model posits that the experience of distress will affect the vulnerability factor. We were specifically interested in evaluating the effects of a specific stressor (spontaneous panic) as well as general distress on changes in AS over time. A large nonclinical sample of young adults (N = 1296) was prospectively followed over a five week highly stressful period of time (i.e. military basic training). Findings were consistent with the Scar model and suggested that the specific stressor of experiencing a panic attack as well as general stressors creating significant anxiety symptoms uniquely contributed to increased levels of AS (regardless of prior history of panic). Moreover, the experience of spontaneous panic in the context of generally low levels of distress (both anxiety and depression) appeared to be particularly pernicious in terms of resulting in greater increases in AS. In sum, anxiety-related stressors appear to have the potential to 'scar' individuals in regard to this cognitive vulnerability factor.

Differential roles of depressive and anxious symptoms and gender in defensiveness

Among a sample of Air Force cadets facing the prospect of basic training (N= 1,190; 1,005 men and 185 women), the influence of a defensive test-taking style on measures of depressive and anxious symptoms was examined. Participants completed the Beck Depression Inventory (Beck & Steer, 1987) and the Beck Anxiety Inventory (Beck, Epstein, Brown, & Steer, 1988), as well as the MMPI (Hathaway & McKinley, 1943) L scale. Results supported hypotheses that defensiveness would affect a self-report measure of depression but not a self-report measure of anxiety and would do so more among men than women. Applied implications of the results are discussed.

Dismantling cognitive-behavioral treatment for panic disorder: questioning the utility of breathing retraining

Cognitive-behavioral treatment (CBT) protocols for panic disorder (PD) consist of a set of interventions that often includes some form of breathing retraining (BR). A controlled outcome study was designed to assess the necessity of BR in the context of a multicomponent CBT protocol. To accomplish this, patients with PD (N = 77) were randomly assigned to receive CBT with or without BR or to a delayed-treatment control. The main study hypothesis was that patients receiving BR would display a less complete recovery relative to the other active-treatment condition given that BR appears to be a more attractive (but less adaptive) option for some patients. Some data suggested that the addition of BR yielded a poorer outcome. However, findings were generally more consistent with treatment equivalence, questioning whether BR produces any incremental benefits in the context of other CBT interventions for PD.

Dismantling cognitive-behavioral treatment for panic disorder: questioning the utility of breathing retraining

Cognitive-behavioral treatment (CBT) protocols for panic disorder (PD) consist of a set of interventions that often includes some form of breathing retraining (BR). A controlled outcome study was designed to assess the necessity of BR in the context of a multicomponent CBT protocol. To accomplish this, patients with PD (N = 77) were randomly assigned to receive CBT with or without BR or to a delayed-treatment control. The main study hypothesis was that patients receiving BR would display a less complete recovery relative to the other active-treatment condition given that BR appears to be a more attractive (but less adaptive) option for some patients. Some data suggested that the addition of BR yielded a poorer outcome. However, findings were generally more consistent with treatment equivalence, questioning whether BR produces any incremental benefits in the context of other CBT interventions for PD.

Evaluating gene x psychological risk factor effects in the pathogenesis of anxiety: a new model approach

The present study evaluated the singular and interactive effects of a functional polymorphism (variation) in the serotonin transporter (5-HTT) gene and a psychological trait (anxiety sensitivity [AS], i.e., fear of arousal symptoms) in predicting subjective and physiological responses to a 35% carbon dioxide (CO2) challenge in a community sample (N = 72). Genotypes were divided into 2 groups in accord with prior research. Findings were partially supportive of the hypothesized risk model. These indicated that the Group L genotype (homozygous for the 1 allele), compared with the Group S genotype (homozygous for the s allele plus heterozygous individuals), predicted greater fearful response to the biological challenge. There was also an AS x Genotype interaction predicting heart rate variability (HRV) in response to the CO2, suggesting that high AS plus Group L status predicts decreased HRV.

The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: quality versus quantity

Cognitive-behavioral therapy (CBT) is skill based and assumes active patient participation in regard to treatment-related assignments. The effects of patient compliance in CBT outcome studies are equivocal, however, and 1 gap in the literature concerns the need to account for the quality versus the quantity of assigned work. In this study, both quality and quantity of home-based practice were assessed to better evaluate the effects of treatment compliance in patients with panic disorder (N = 48) who participated in a 12-session CBT protocol. Patient estimates of compliance were not significantly associated with most outcome measures. On the other hand, therapist ratings of compliance significantly predicted positive changes on most outcome measures. Moreover, therapist and independent rater estimates of the quality of the participant's work, relative to the quantity of the work, were relatively better predictors of outcome.

Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension

Increasing evidence suggests that anxiety sensitivity (AS) may be a premorbid risk factor for the development of anxiety pathology. The principal aim of this study was to replicate and extend a previous longitudinal study evaluating whether AS acts as a vulnerability factor in the pathogenesis of panic (N. Schmidt, D. Lerew, & R. Jackson, 1997). A large nonclinical sample of young adults (N = 1,296) was prospectively followed over a 5-week, highly stressful period of time (i.e., military basic training). Consistent with the authors' initial study, AS predicted the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety, and AS was found to possess symptom specificity with respect to anxiety versus depression symptoms. AS 1st-order factors differentially predicted panic attacks, with the Mental Concerns factor being the best predictor of panic in this sample.

Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension

Increasing evidence suggests that anxiety sensitivity (AS) may be a premorbid risk factor for the development of anxiety pathology. The principal aim of this study was to replicate and extend a previous longitudinal study evaluating whether AS acts as a vulnerability factor in the pathogenesis of panic (N. Schmidt, D. Lerew, & R. Jackson, 1997). A large nonclinical sample of young adults (N = 1,296) was prospectively followed over a 5-week, highly stressful period of time (i.e., military basic training). Consistent with the authors' initial study, AS predicted the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety, and AS was found to possess symptom specificity with respect to anxiety versus depression symptoms. AS 1st-order factors differentially predicted panic attacks, with the Mental Concerns factor being the best predictor of panic in this sample.

Physiological hyperarousal: construct validity of a central aspect of the tripartite model of depression and anxiety

Physiological hyperarousal (PH) is an understudied component of the tripartite model of depression and anxiety. This study contributes to the literature on PH, the tripartite model, and anxiety and its disorders, using data from psychotherapy outpatients (n = 2,448), air force cadets (n = 1,335), and undergraduates (n = 284). Psychometrics and exploratory and confirmatory factor analyses showed that PH is a reliable, cohesive, discriminable, and valid construct. Compared with subjective anxiety, PH was more associated to panic versus mood disordered status, and to panic versus generalized anxiety disordered status. As hypothesized, an aspect of anxiety sensitivity (i.e., fear of body sensations) was particularly related to subjective anxiety in the presence of PH. Results support the PH construct as replicable, valid, and clinically important and support the utility of the tripartite and related models for understanding the relation of depressive and anxious syndromes.

Evaluation of psychological risk factors: prospective prediction of psychopathology during basic training

OBJECTIVE

Three theoretically derived cognitive risk factors were evaluated to determine whether they predicted the development of stress responding in the context of Basic Cadet Training (BCT).

METHOD

A large sample of cadets (N = 1,401) was prospectively followed for the 5-week BCT period.

RESULTS

All risk factors were found to significantly and independently predict the development of psychopathology and impairment as well as changes in symptoms during basic training. Risk factors conveyed approximately two to five times greater likelihood of experiencing clinically significant levels of symptoms at the end of BCT.

CONCLUSIONS

These data provide strong evidence for three psychological risk factors in the development of anxiety and mood symptoms. Implications for screening and primary prevention are discussed.

Physiological hyperarousal: construct validity of a central aspect of the tripartite model of depression and anxiety

Physiological hyperarousal (PH) is an understudied component of the tripartite model of depression and anxiety. This study contributes to the literature on PH, the tripartite model, and anxiety and its disorders, using data from psychotherapy outpatients (n = 2,448), air force cadets (n = 1,335), and undergraduates (n = 284). Psychometrics and exploratory and confirmatory factor analyses showed that PH is a reliable, cohesive, discriminable, and valid construct. Compared with subjective anxiety, PH was more associated to panic versus mood disordered status, and to panic versus generalized anxiety disordered status. As hypothesized, an aspect of anxiety sensitivity (i.e., fear of body sensations) was particularly related to subjective anxiety in the presence of PH. Results support the PH construct as replicable, valid, and clinically important and support the utility of the tripartite and related models for understanding the relation of depressive and anxious syndromes.

Effects of anxiety sensitivity on anxiety and pain during a cold pressor challenge in patients with panic disorder

Fear of anxiety symptoms, or anxiety sensitivity (AS), has been extensively studied in anxiety disorders and more recently has been linked to other psychopathological conditions including pain. Asmundson and colleagues have suggested that AS may act as a risk factor for chronic pain and several studies have demonstrated an association between AS, avoidance behaviors and pain. The present study assessed whether AS levels would be predictive of pain and anxiety during a brief pain induction task. Clinical participants meeting DSM-IV criteria for panic disorder (n = 22) were age and sex matched with nonclinical controls (n = 22) and exposed to a 2-min cold pressor challenge. Diagnostic status and AS were significantly predictive of pain and anxiety during the cold pressor task. Moreover, AS appears to mediate the relationship between diagnostic status and pain. However, AS appears to be only indirectly associated with pain through its contribution to anxiety.

Excessive reassurance-seeking predicts depressive but not anxious reactions to acute stress

The authors hypothesized that excessive reassurance-seeking would prospectively predict changes in depressive symptoms, even controlling for changes in anxious symptoms, and would not predict changes in anxious symptoms controlling for changes in depressive symptoms. This prediction was supported in a study of 1,005 air force cadets. Participants completed measures of excessive reassurance-seeking and depressive and anxious symptoms before basic training, and completed symptom measures again following basic training. This study, together with others, demonstrates that excessive reassurance-seeking is an important depression-related variable that deserves serious attention as a potential vulnerability factor.

Excessive reassurance-seeking predicts depressive but not anxious reactions to acute stress

The authors hypothesized that excessive reassurance-seeking would prospectively predict changes in depressive symptoms, even controlling for changes in anxious symptoms, and would not predict changes in anxious symptoms controlling for changes in depressive symptoms. This prediction was supported in a study of 1,005 air force cadets. Participants completed measures of excessive reassurance-seeking and depressive and anxious symptoms before basic training, and completed symptom measures again following basic training. This study, together with others, demonstrates that excessive reassurance-seeking is an important depression-related variable that deserves serious attention as a potential vulnerability factor.

Factor structure of a measure of anxiety sensitivity in children

Anxiety sensitivity (i.e., the disposition to react to autonomic arousal with fear) has taken a central role in recent conceptualizations of anxiety. However, questions regarding the dimensional nature of anxiety sensitivity remain. In particular, the factor structure of anxiety sensitivity is unexplored in nonadult populations. The factor structure of the Anxiety Sensitivity Index for Children (ASIC) was examined in three studies. Study 1 (N = 95) used a sample of school children in Grades 4-8 to investigate the reliability of items and factor structure. Items with weak psychometric properties were eliminated, and subsequent analyses revealed that the ASIC was best viewed as a hierarchical scale with a higher order factor (Anxiety Sensitivity) and two first-order factors (Fear of Physiological Arousal and Fear of Mental Catastrophe). Study 2 (N = 112) and Study 3 (N = 144) used more distressed samples of youngsters, and they also found the ASIC to be a hierarchical scale. These findings add a developmental perspective to the Anxiety Sensitivity Index factor analytic discussion and are highly consistent with emergent thinking in the adult anxiety sensitivity literature.

Anxiety sensitivity and the pathogenesis of anxiety and depression: evidence for symptom specificity

Expectancy theory posits that anxiety sensitivity (AS) acts as a specific risk factor for the development of anxiety pathology (Reiss, 1991). Previous work suggests that AS is a risk factor for anxiety but several reports have found that AS is also related to depression. The principal aim of the present study was to determine whether anxiety sensitivity acts as a specific vulnerability factor in the pathogenesis of anxiety and depression in both a large nonclinical sample (N = 1401) as well as a patient sample (N = 53). A covariance analytic strategy indicated that AS possesses symptom specificity with respect to anxiety but is not predictive of depression when accounting for changes in anxiety symptoms. Component analyses suggest, however, that one first-order factor (phrenophobia) is likely to account for the association between AS and depression because it is non-specific (i.e. associated with unique aspects of both anxiety and depression). It is concluded that much of the general association noted between anxiety sensitivity and depression is likely to be due to covariation among symptoms of anxiety and depression.

Extinction of panicogenic effects of a 35% CO2 challenge in patients with panic disorder

Inhalations of high concentrations of carbon dioxide (CO2) reliably produce panic attacks in patients with panic disorder. The present study evaluated whether cognitive-behavioral treatment (CBT) for panic disorder would extinguish CO2-induced panic and whether changes in panic and arousal-related cognitions were associated with the induction of panic. Patients with panic disorder (N = 54) were assigned to 1 of 3 experimental conditions: CBT with respiratory training (CBT-R), CBT without respiratory training (CBT), or delayed treatment. Participants received 5 repeated vital-capacity inhalations of 35% CO2/65% O2 prior to and following either 12 treatment sessions or a 12-week waiting period. During pretreatment assessments, 74% of patients experienced a panic attack during at least 1 inhalation. At posttreatment, only 20% of treated participants (CBT-R = 19%, CBT = 22%), compared with 64% of untreated participants, panicked. Forty-four percent of treated participants, compared with 0% of untreated participants, reported no anxiety during all posttreatment inhalations. Anxiety sensitivity as well as panic appraisals regarding the likelihood of panic and self-efficacy with coping with panic were significantly related to fearful responding to the CO2 challenge.

The role of anxiety sensitivity in the pathogenesis of panic: prospective evaluation of spontaneous panic attacks during acute stress

Expectancy theory posits that anxiety sensitivity may serve as a premorbid risk factor for the development of anxiety pathology (S. Reiss, 1991). The principal aim of the present study was to determine whether anxiety sensitivity acts as a specific vulnerability factor in the pathogenesis of anxiety pathology. A large, nonclinical sample of young adults (N = 1,401) was prospectively followed over a 5-week highly stressful period of time (i.e., military basic training). Anxiety sensitivity was found to predict the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety. Approximately 20% of those scoring in the upper decile on the Anxiety Sensitivity Index (R. A. Peterson & S. Reiss, 1987) experienced a panic attack during the 5-week follow-up period compared with only 6% for the remainder of the sample. Anxiety sensitivity also predicted anxiety symptomatology, functional impairment created by anxiety, and disability. These data provide strong evidence for anxiety sensitivity as a risk factor in the development of panic attacks and other anxiety symptoms.

The role of anxiety sensitivity in the pathogenesis of panic: prospective evaluation of spontaneous panic attacks during acute stress

Expectancy theory posits that anxiety sensitivity may serve as a premorbid risk factor for the development of anxiety pathology (S. Reiss, 1991). The principal aim of the present study was to determine whether anxiety sensitivity acts as a specific vulnerability factor in the pathogenesis of anxiety pathology. A large, nonclinical sample of young adults (N = 1,401) was prospectively followed over a 5-week highly stressful period of time (i.e., military basic training). Anxiety sensitivity was found to predict the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety. Approximately 20% of those scoring in the upper decile on the Anxiety Sensitivity Index (R. A. Peterson & S. Reiss, 1987) experienced a panic attack during the 5-week follow-up period compared with only 6% for the remainder of the sample. Anxiety sensitivity also predicted anxiety symptomatology, functional impairment created by anxiety, and disability. These data provide strong evidence for anxiety sensitivity as a risk factor in the development of panic attacks and other anxiety symptoms.

Body vigilance in panic disorder: evaluating attention to bodily perturbations

Body vigilance, consciously attending to internal cues, is a normal adaptive process. The present report investigated whether body vigilance is exaggerated among those with panic disorder, a condition characterized by intense fear and worry regarding bodily sensations. The Body Vigilance Scale is validated in nonclinical and anxiety disorder samples. Study 1 suggests that body vigilance is normally distributed in a nonclinical sample (n = 472) but vigilance is related to a history of spontaneous panic attacks, anxiety symptomatology, and anxiety sensitivity. Study 2 suggests that body vigilance is elevated in panic disorder patients (n = 48) relative to social phobia patients (n = 18) and nonclinical controls (n = 71). During cognitive-behavioral treatment, panic disorder patients show substantial reductions in body vigilance associated with reductions in anxiety symptomatology. Anxiety sensitivity was found to be related to body vigilance and to predict changes in body vigilance during treatment.

Body vigilance in panic disorder: evaluating attention to bodily perturbations

Body vigilance, consciously attending to internal cues, is a normal adaptive process. The present report investigated whether body vigilance is exaggerated among those with panic disorder, a condition characterized by intense fear and worry regarding bodily sensations. The Body Vigilance Scale is validated in nonclinical and anxiety disorder samples. Study 1 suggests that body vigilance is normally distributed in a nonclinical sample (n = 472) but vigilance is related to a history of spontaneous panic attacks, anxiety symptomatology, and anxiety sensitivity. Study 2 suggests that body vigilance is elevated in panic disorder patients (n = 48) relative to social phobia patients (n = 18) and nonclinical controls (n = 71). During cognitive-behavioral treatment, panic disorder patients show substantial reductions in body vigilance associated with reductions in anxiety symptomatology. Anxiety sensitivity was found to be related to body vigilance and to predict changes in body vigilance during treatment.

Nonpsychiatric medical comorbidity, health perceptions, and treatment outcome in patients with panic disorder

Panic disorder is frequently complicated by high rates of co-occurring nonpsychiatric medical conditions. The present study examined the relationship between medical morbidity, perceived physical health, and treatment outcome in panic disorder. Patients meeting the American Psychiatric Association's Diagnostic and Statistical Manual of mental disorders (1994) criteria for panic disorder (N = 71) completed 12 sessions of cognitive-behavioral treatment and were assessed at posttreatment and 6-month follow-up. Medical comorbidity and perceived health were both found to be related to end-state functioning. Medical comorbidity did not uniquely predict outcome beyond its shared variance with perceived health. At posttreatment, 71% of patients who perceived their physical health as good met recovery criteria compared with only 35% of those who perceived their health as poor. At follow-up, 67% of those who perceived their physical health as good met composite recovery criteria compared with only 33% of those with perceived poor health. These findings offer preliminary support for the impact of physical health, both actual and perceived, on treatment outcome of patients with panic disorder.

Perfectionism, perceived weight status, and bulimic symptoms: two studies testing a diathesis-stress model

Among a total of 890 women from 2 separate nonclinical samples (1 collected in 1982 on college undergraduates, n = 435, and 1 collected in 1992 on women who were in college in 1982, n = 455), the authors tested a diathesis-stress model of the interrelations of perfectionism, perceived weight status, and bulimic symptoms. The authors predicted and found that perfectionism served as a risk factor for bulimic symptoms for women who perceived themselves as overweight but did not serve as a risk factor for those who did not perceive themselves as overweight. Perceived weight activated perfectionism as a predictor of bulimic symptoms; actual weight did not serve the same role. These findings are discussed in the context of recent clinical and social psychological theory regarding development of bulimic symptoms.

Efficacy of a brief psychosocial treatment for panic disorder in an active duty sample: implications for military readiness

OBJECTIVE

The efficacy of a brief cognitive-behavioral treatment for panic in military personnel was evaluated.

METHOD

Active duty military patients (N = 37) presenting at outpatient psychiatry and psychology clinics were randomly assigned to immediate or delayed treatment conditions. All patients met Diagnostic and Statistical Manual of Mental Disorders criteria for a primary diagnosis of panic disorder with or without agoraphobia.

RESULTS

At posttreatment, 80% of the immediate treatment group, compared to 0% of the delayed treatment group, met recovery criteria on all major clinical facets of panic disorder (i.e., panic attacks, panic-related worry, phobic avoidance). At follow-up, 75% of the treated group continued to meet recovery criteria, suggesting maintenance of treatment gains. A majority of those patients (58%) taking benzodiazepines at the start of treatment were successfully discontinued by posttreatment.

CONCLUSIONS

Brief, skill-based treatments for panic disorder are effective for a majority of active duty personnel. These treatments may also improve military readiness by facilitating benzodiazepine discontinuation.

Global self-esteem as contingent on body satisfaction among patients with bulimia nervosa: lack of diagnostic specificity?

OBJECTIVE

To examine whether the self-esteem of patients with bulimia nervosa was more contingent on body satisfaction than that of nonpsychiatric control and of depressed participants.

METHODS

Patients with bulimia nervosa (selected according to DSM-III-based structured clinical interviews), those with depression (selected based on chart diagnoses), and nonpsychiatric control samples completed measures of body dissatisfaction and of global self-esteem.

RESULTS

Consistent with past work, we found that body dissatisfaction accounted for a greater amount of global self-esteem among bulimia nervosa patients, as compared to nonpsychiatric control subjects. However, the relation between global self-esteem and body dissatisfaction was similar in patients with bulimia nervosa as in those with depression. Although our depressed group possessed bulimic characteristics, this did not appear to account for our findings, in that the correlation between body dissatisfaction and self-esteem was highest among the nonbulimic depressed participants.

DISCUSSION

Our results raise questions about the specific pathognomonic quality of body satisfaction-dependent self-esteem in bulimia nervosa.

Biological challenge manipulation of PCO2 levels: a test of Klein's (1993) suffocation alarm theory of panic

D.F. Klein (1993) proposed that patients with panic disorder (PD) have a hypersensitive suffocation monitor that predisposes them to experience panic attacks under certain conditions. The suffocation alarm theory predicts differential emotional responding to biological challenges that affect arterial partial pressure of carbon dioxide (PCO2). These PD patients should exhibit (a) lower fear and less likelihood of panic in response to biological challenges that lower PCO2 levels (e.g., hyperventilation), and (b) increased fear and greater likelihood of panic in response to biological challenges that raise PCO2 levels (e.g., inhalation of 35% CO2 gas). The following indicators of the suffocation monitor were assessed: (a) severity of dyspnea symptoms, (b) frequency of dyspnea symptoms, (c) heightened respiration rate, and (d) lowered PCO2 levels. Ratings of physiological and subjective responding, as well as panic, were obtained during both a hyperventilation and a 35% CO2 challenge. None of the classification methods predicted differential emotional responding to hyperventilation versus 35% CO2 challenge.

Low-end specificity of childhood measures of emotional distress: differential effects for depression and anxiety

This study examined the low-end specificity of self-report measures of anxious and depressed symptoms among a clinical sample of 96 child and adolescent psychiatric inpatients (54 boys, 42 girls; ages 8 to 16; M = 12.34, SD = 2.43). To our knowledge, the study is one of the first to examine the issue in a clinical sample, and the first to address this issue in children and adolescents. Participants completed the Children's Depression Inventory (CDI) and the Revised Children's Manifest Anxiety Scale (RCMAS). As predicted, CDI low-end participants obtained higher RCMAS Lie scale scores than depressed participants, suggesting a tendency to deny symptoms and to attempt to appear in a favorable light. In contrast, but also consistent with prediction, low-end RCMAS participants did not obtain higher Lie scale scores than anxious participants. Gender and age did not moderate the findings in any way. Thus, our results support hypotheses that defensiveness would affect a self-report measure of depression but not a self-report measure of anxiety. Recommendations for addressing low-end specificity problems in both research and clinical work are discussed.

Biological challenge manipulation of PCO2 levels: a test of Klein's (1993) suffocation alarm theory of panic

D.F. Klein (1993) proposed that patients with panic disorder (PD) have a hypersensitive suffocation monitor that predisposes them to experience panic attacks under certain conditions. The suffocation alarm theory predicts differential emotional responding to biological challenges that affect arterial partial pressure of carbon dioxide (PCO2). These PD patients should exhibit (a) lower fear and less likelihood of panic in response to biological challenges that lower PCO2 levels (e.g., hyperventilation), and (b) increased fear and greater likelihood of panic in response to biological challenges that raise PCO2 levels (e.g., inhalation of 35% CO2 gas). The following indicators of the suffocation monitor were assessed: (a) severity of dyspnea symptoms, (b) frequency of dyspnea symptoms, (c) heightened respiration rate, and (d) lowered PCO2 levels. Ratings of physiological and subjective responding, as well as panic, were obtained during both a hyperventilation and a 35% CO2 challenge. None of the classification methods predicted differential emotional responding to hyperventilation versus 35% CO2 challenge.

Factors influencing health perceptions in patients with panic disorder

Subjective perceptions of health have been found to be related to a variety of consequential variables including health care utilization and mortality. A number of studies have found that patients with panic disorders generally perceive themselves as having poor health. However, factors underlying self-perceptions of health are largely unexplored in this population. The present study examined three factors believed to contribute to health perceptions: (1) presence of comorbid medical conditions, (2) tendency to somaticize or worry about health, and (3) level of co-occurring depression. The sample consisted of 81 patients who met DSM-III-R criteria for panic disorder. An assessment battery that determined self-perceptions of health, level of depression, and the major clinical dimensions of panic disorder (i.e., panic attacks, anxiety, and phobic avoidance) was administered to all participants. As predicted, analyses indicated that each of the hypothesized factors was significantly related to poorer perceived health. Setwise hierarchical multiple regression analyses controlling for demographic variables indicated that health perceptions are strongly and independently associated with depression and the presence of a medical condition. Subjective health perceptions in panic disorder are multifactorial and are related to both realistic appraisals of health and distorted perceptions caused by depressed mood.

Prospective evaluation of panic potentiation following 35% CO2 challenge in nonclinical subjects

OBJECTIVE

The authors examined the effect of panic provocation on the subsequent development of panic attacks and panic disorder in nonclinical subjects with no history of spontaneous panic.

METHOD

Sixty-two subjects who had completed a study examining fearful responses to a single vital capacity inhalation of 35% CO2 were reevaluated 1 year following the challenge test.

RESULTS

Challenge-induced panic was not related to the later development of panic or panic disorder. According to the Structured Clinical Interview for DSM-III-R--Non-Patient Edition, none of the subjects met DSM-III-R criteria for panic disorder and only six subjects reported spontaneous panic during the year after panic provocation. Of the six subjects who experienced spontaneous panic, two had panicked in response to the CO2 challenge.

CONCLUSIONS

The experimental provocation of panic in nonclinical subjects appears to be a safe research paradigm for exploring the psychopathogenicity of panic disorder.

Impact of cognitive-behavioral treatment on quality of life in panic disorder patients

Panic disorder (PD) is associated with significant social and health consequences. The present study examined the impact of treatment on PD patients' quality of life. Patients (N = 156) meeting DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]; American Psychiatric Association, 1987) criteria for PD with agoraphobia were randomly assigned to group cognitive-behavioral treatment (CBT) or a delayed-treatment control. An assessment battery measuring the major clinical features of PD as well as quality of life was administered at baseline (Week 0), post-treatment (Week 9) and 6-month follow-up (Week 35). Consistent with previous studies, PD patients displayed significant impairment in quality of life at intake. Compared with delayed-treatment control participants, CBT-treated participants showed significant reductions in impairment that were maintained at follow-up. Consistent with prediction, anxiety and phobic avoidance were significantly associated with quality of life, whereas frequency of panic attacks was not.

Cognitive-behavioral treatment of body dysmorphic disorder: a case report

Body dysmorphic disorder (BDD) refers to preoccupation with an imagined physical defect or the exaggeration of a slight physical anomaly. Since BDD's inclusion in the DSM-III-R, there have been only a handful of reports of its cognitive-behavioral treatment. We describe one successful short-term cognitive-behavioral therapy treatment of a BDD patient whose presenting concern was small hand size. After nine sessions of therapy, the patient evidenced substantial change on indices measuring affective, cognitive, and behavioral facets of BDD. There was also clinically meaningful improvement in overall levels of depression and anxiety. It is suggested that cognitive-behavioral treatment programs for BDD should take into account comorbid conditions such as social phobia, and avoidant personality disorder.

The overprediction of fear and panic in panic disorder

The present study examined changes in the prediction of fear and panic in a clinical sample of patients (N = 25) meeting DSM-III-R criteria for panic disorder with agoraphobia (PDA). Data were collected for approx. 2000 trials of in vivo exposure. As expected, PDA patients displayed a bias for overpredicting both the level of fear and the likelihood of panic during an exposure trial. This overprediction bias was evidenced across several domains including heights, transportation and social situations. Although patients learned to make more accurate predictions within an exposure session, the level of overprediction remained relatively stable after the third trial within a session. Changes in fear overprediction differed across fear domains. Patients showed significant reductions in overprediction during exposure to transportation and social situations, but failed to show reductions in overprediction during exposure to heights. Unexpectedly, patients did not show increased prediction accuracy across sessions. These findings concur with earlier laboratory studies indicating that anxiety patients show an overprediction bias for panic and fear which decreases with practice. However, our findings indicate that the overprediction bias does not remit even after significant practice. The persistence of the overprediction bias is discussed within an evolutionary context.

Waist-to-hip ratio and body dissatisfaction among college women and men: moderating role of depressed symptoms and gender

We examined the interrelationships of waist-to-hip ratio (WHR), body dissatisfaction, gender, and depressed and eating disordered symptoms cross-sectionally among 131 male and female undergraduates. Based on past findings on physical and mental health, attractiveness, and depressive realism, we predicted that the WHR x Depression x Gender interaction would be significantly related to body dissatisfaction, such that the correspondence between WHR and body dissatisfaction would be more pronounced among depressed than among nondepressed women and men. This hypothesis received support. Implications of our results for work on body dissatisfaction were discussed.

Group cognitive-behavioral treatment of panic disorder

The present study examined the efficacy of an 8-wk, cognitive-behavioral group treatment for panic disorder. Patients meeting DSM-III-R criteria for panic disorder with or without agoraphobia were randomly assigned to treatment (N = 34) or delayed treatment control (N = 33). The treatment consisted of: (a) education and corrective information; (b) cognitive therapy; (c) training in diaphragmatic breathing; and (d) interoceptive exposure. At posttreatment, 85% of treated Ss were panic free, compared to 30% of controls. Treated Ss also showed clinically significant improvement on indices of anxiety, agoraphobia, depression and fear of fear. Recovery, as estimated conservatively by the attainment of normal levels of functioning on each of the major clinical dimensions of the disorder (i.e. panic, anxiety and avoidance), was achieved in 64% of the treated Ss and 9% of the controls. At the 6 month follow-up, 63% of the treated patients met criteria for recovery. These findings mirror those from recently-completed trials of individually-administered cognitive-behavioral treatment, and suggest that CBT is a viable alternative to pharmacotherapy in the treatment of panic disorder.