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Lippert MW, Sommer K, Flasinski T, Pflug V, Rölver A, Christiansen H, In-Albon T, Knappe S, Romanos M, Tuschen-Caffier B, Schneider S. Personalized Assessment of Anxiety and Avoidance in Children and Their Parents-Development and Evaluation of the Anxiety and Avoidance Scale for Children. Front Psychol 2021; 12:703784. [PMID: 34867587 PMCID: PMC8635988 DOI: 10.3389/fpsyg.2021.703784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/27/2021] [Indexed: 01/25/2023] Open
Abstract
In treating childhood anxiety disorders, therapists use highly individualized anxiety hierarchies to assess anxiety-eliciting situations and to personalize treatment. In contrast, psychometric assessment of anxiety symptoms in children usually consists of standardized questionnaires, assessing either total anxiety or disorder-specific symptom scores, prioritizing comparability over individual information. To account for interindividual differences, the Anxiety and Avoidance Scale for Children (AVAC) was developed, following a precise, personalized, assessment approach. In responding to the questionnaire, children and parents identify the most anxiety-eliciting situations before starting treatment, and rate them for anxiety and avoidance. Ratings are repeated over the course of treatment. The aim of this study is to introduce the new questionnaire and present first data on psychometric properties. The AVAC was administered to 389 children with separation anxiety disorder (N = 148), social anxiety disorder (N = 110) or specific phobia (N = 131) aged 8 to 16 and their parents, along with other measures of anxiety and psychopathology before and after cognitive behavioral treatment. Results showed adequate to good test-retest reliability. The AVAC items correlated significantly with established anxiety questionnaires, indicating convergent construct validity. Regarding divergent construct validity, the AVAC showed only small correlations with externalizing symptoms, demonstrating its precision in measuring anxiety and avoidance. The questionnaire was also sensitive to change after treatment, with medium to large effects in the reduction of anxiety and avoidance. The present analyses suggest that the new personalized assessment approach with the AVAC is a reliable and valid assessment of individualized anxiety and avoidance, as well as change in those constructs over the course of CBT treatment.
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Affiliation(s)
- Michael W. Lippert
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Katharina Sommer
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Tabea Flasinski
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Verena Pflug
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Angela Rölver
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinic Münster, Münster, Germany
| | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | | | - Silvia Schneider
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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Schulz A, Rost S, Flasinski T, Dierolf AM, Lutz APC, Münch EE, Mertens VC, Witthöft M, Vögele C. Distinctive body perception mechanisms in high versus low symptom reporters: A neurophysiological model for medically-unexplained symptoms. J Psychosom Res 2020; 137:110223. [PMID: 32866840 DOI: 10.1016/j.jpsychores.2020.110223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The neurophysiological processes involved in the generation of medically-unexplained symptoms (MUS) remain unclear. This study tested three assumptions of the perception-filter model contributing to MUS: (I.) increased bodily signal strength (II.) decreased filter function, (III.) increased perception. METHODS In this cross-sectional, observational study, trait MUS were assessed by a web-based survey (N = 486). The upper and lower decile were identified as extreme groups of high (HSR; n = 29; 26 women; Mage = 26.0 years) and low symptom reporters (LSR; n = 29; 21 women; Mage = 28.4 years). Mean heart rate (HR) and heart rate variability (HRV), and cortisol awakening response (CAR) were assessed as indicators of bodily signal strength (I.). Heartbeat-evoked potentials (HEPs) were assessed during rest and a heartbeat perception task. HEPs reflect attentional resources allocated towards heartbeats and served as index of filter function (II.). Interoceptive accuracy (IAc) in heartbeat perception was assessed as an indicator of perception (III.). RESULTS HSR showed higher HR and lower HRV (RMSSD) than LSR (I.), but no differences in CAR. HSR exhibited a stronger increase of HEPs when attention was focused on heartbeats than LSR (II.); there were no group differences in IAc (III.). CONCLUSIONS The perception-filter model was partially confirmed in that HSR showed altered bodily signals suggesting higher sympathetic activity (I.); higher HEP increases indicated increased filter function for bodily signals (II.). As more attentional resources are mobilized to process heartbeats, but perception accuracy remains unchanged (III.), this overflow could be responsible for detecting minor bodily changes associated with MUS.
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Affiliation(s)
- André Schulz
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
| | - Silke Rost
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Tabea Flasinski
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Angelika M Dierolf
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Annika P C Lutz
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Eva E Münch
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Vera-Christina Mertens
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg; HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Michael Witthöft
- Division of Clinical Psychology, Department of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Claus Vögele
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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Flasinski T, Dierolf AM, Rost S, Lutz APC, Voderholzer U, Koch S, Bach M, Asenstorfer C, Münch EE, Mertens VC, Vögele C, Schulz A. Altered Interoceptive Awareness in High Habitual Symptom Reporters and Patients With Somatoform Disorders. Front Psychol 2020; 11:1859. [PMID: 32849092 PMCID: PMC7426478 DOI: 10.3389/fpsyg.2020.01859] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/07/2020] [Indexed: 01/07/2023] Open
Abstract
Objective: Altered interoception may play a major role in the etiology of medically unexplained symptoms (MUS). It remains unclear, however, if these alterations concern noticing of signals or if they are limited to the interpretation of signals. We investigated whether individuals with MUS differ in interoceptive awareness as assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. Methods: Study 1: A total of 486 individuals completed the Screening for Somatoform Disorders (SOMS-2). Thirty-two individuals each of the upper and lower decile of the SOMS distribution (low symptom reporters/LSR, high symptom reporters/HSR) completed the MAIA. Study 2: MAIA scores of individuals diagnosed with somatoform disorder (SFD; n = 26) were compared to individuals with major depressive disorder (MDD; n = 25) and healthy controls (HC; n = 26). Results: HSR had lower scores than LSR on the MAIA scales Not-Distracting and Not-Worrying. The SFD and MDD groups showed lower scores than HC on the MAIA scales Not-Distracting, Self-Regulation, and Trusting. The MDD group scored lower than the other two groups on the scales Body Listening and Attention Regulation. There were no group differences on the scale Noticing. Conclusion: HSR, SFD, and MDD patients do not differ from HC in the awareness of noticing of interoceptive signal processing, whereas cognitive facets of interoception, such as distraction or self-regulation are differentially affected. This highlights the necessity of including specifically targeted interventions, which improve interoceptive awareness, in the prevention and treatment of SFDs.
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Affiliation(s)
- Tabea Flasinski
- Clinical Psychophysiology Laboratory, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Angelika Margarete Dierolf
- Clinical Psychophysiology Laboratory, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Silke Rost
- Clinical Psychophysiology Laboratory, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Annika P C Lutz
- Clinical Psychophysiology Laboratory, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | | | - Stefan Koch
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
| | | | | | - Eva Elisabeth Münch
- Clinical Psychophysiology Laboratory, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Vera-Christina Mertens
- Clinical Psychophysiology Laboratory, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Claus Vögele
- Clinical Psychophysiology Laboratory, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - André Schulz
- Clinical Psychophysiology Laboratory, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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