Depression, anxiety and quality of life: outcome 9 months after facial cosmetic surgery

OBJECTIVE

The request for cosmetic surgery is of a psychological nature. Very few studies have quantitatively assessed whether or not this psychological need was actually satisfied, and more precisely, which psychic components were satisfied.

MATERIAL AND METHODS

This is a multicentric, prospective cohort study. One hundred and three patients scheduled for facial cosmetic surgery from three different hospitals were examined before and after surgery using four assessment scales validated using European populations. The Montgomery and Asberg depression rating scale (MADRS) measured the existence and intensity of depression, the self-assessment test of thoughts in social interaction (SISST) measured the positive or inhibitory thoughts in the context of social relationships, and the European quality of life 5 dimensions (EQ-5D) (generic test) measured the quality of life. In addition, a semi-directive interview was specially created by our team. For statistical analysis, ANOVA and Student's t test were applied.

RESULTS

Twenty-four patients were lost to follow-up. Although the initial MADRS index was high (p<0.05), it did not change after surgery (p>0.1). SISST+ (positive thoughts): the social anxiety of the individual examined was significantly greater than that of the control group (p<0.005) and improved after surgery (p<0.01). The SISST- (inhibitory thoughts) did not change (p>0.1). The EQ-5D visual analogue scale (VAS) did not reveal any difference (p>0.1) while the descriptive EQ-5D demonstrated over-representation of anxiety/depression (p<0.01), and an improvement of this (p<0.05) postoperatively. The mean subjective satisfaction index was 8.1 (scale of 1-10) without sharing any influence of the complications suffered (65% of the patients made self-assessments).

CONCLUSION

The best indications for facial cosmetic surgery seem to be a lack of self-confidence associated with a desire for social interaction, and a request focused on a specific physical feature. The results presented add documentary confirmation to the impression shared by the majority of cosmetic surgeons. However, it was also confirmed that cosmetic surgery is not limited to its technical components, but remains a medical act which must consider the overall effect on the whole patient.

Citalopram in children and adolescents with depression or anxiety

OBJECTIVE

To investigate the efficacy and tolerability of citalopram in children and adolescents.

METHOD

Retrospective chart review of 17 outpatients treated with citalopram at a tertiary care center. Subjects were diagnosed with a depressive or anxiety disorder with or without comorbidities and may have received concurrent medications. The primary outcome measure was the Clinical Global Impression Improvement Scale (CGI-I). Secondary outcome measures were the Children's Depression Rating Scale-Revised (CDRS-R), Inventory of Depressive Symptomatology, and Screen for Child Anxiety-Related Emotional Disorders (SCARED). Adverse effects were assessed via chart documentation.

RESULTS

Patients were treated with a mean citalopram dose of 22.4 +/- 7.3 mg for 12 weeks. Thirteen patients (76%) had CGI-I scores </=2: 8 of 12 patients with depression and 5 of 5 patients with an anxiety disorder. The mean time to response was 7.6 +/- 3.6 weeks. Additionally, 6 of 8 patients had >/=50% reduction from baseline CDRS-R score, with 3 patients (38%) meeting criteria for remission. Three of 4 patients had a >50% reduction for baseline SCARED-parent score. Overall, adverse effects appeared minor and transient. One patient discontinued citalopram due to intolerable adverse effects, and 1 patient required dose reduction.

CONCLUSIONS

Citalopram appears to be effective and well tolerated in this group of children and adolescents with depressive or anxiety disorders and a high degree of comorbidity. Controlled studies in this patient population are indicated.

Nightmares and anxiety in elementary-aged children: is there a relationship

OBJECTIVE

To determine whether a relationship exists between children's anxiety level and nightmare occurrence.

METHOD

A total of 60 kindergarten, second and fourth grade school children and their parents completed questionnaires assessing nightmare occurrence and anxiety.

RESULTS

According to parental report, children who experience nightmares have significantly higher levels of anxiety than children who do not experience nightmares. The results also indicate a relationship between nightmare distress and trait anxiety.

CONCLUSION

These findings suggest that anxiety issues should be considered in children who are experiencing nightmares.

Anxiety and fear level in patients after myocardial infarction over five years of rehabilitation

The aim of the study was to characterise the structure of anxiety and fear in patients after myocardial infarction observed during their five-year rehabilitation. The study group comprised 114 men aged 24-63 years treated at the Chair and Department of Cardiology, Medical University of Lublin with recent myocardial infarction diagnosed according to generally accepted clinical criteria. Besides basic clinical examinations the patients were performed echocardiography and psychological examination. After completion of the first clinical therapy a five-year post-infarct outpatient rehabilitation was organised for the patients. To assess the level of anxiety and fear Cattell's IPAT Self-Analysis was used. The method lets find out that: 1. In every study period the level of general anxiety was close to the neurotic level. 2. During the whole period of five-year rehabilitation in about 60% of patients the normal level of internal integration was observed. 3. In all study periods about 30% of patients showed emotional instability. 4. In the structure of anxiety and fear about 60% of patients always showed high level of inner tension associated with a conflict between superego demands and impulsive sphere. 5. Observation of patients after myocardial infarction lasting many years has shown that the study group is not homogenous as for personality traits. The use of agglomerate analysis allowed distinguishing 7 groups of patients with the most similar personality characteristics. Individual groups of patients significantly differed from one another with regard to the structure of anxiety and fear.

Salivary cortisol determinations and self-rating scales in the assessment of stress in patients undergoing the extraction of wisdom teeth

OBJECTIVE

To investigate salivary cortisol levels in patients undergoing third molar removal under local and general anaesthesia.

DESIGN

Random sampling of two independent groups.

METHODS

Samples of saliva were collected from patients prior to and after surgery for the removal of impacted wisdom teeth. The samples were analysed to assess cortisol levels. Patients were also asked to complete a Hospital Anxiety and Depression questionnaire on the day of surgery.

RESULTS

Patients receiving treatment under local anaesthesia showed lower levels of stress response than those having treatment under general anaesthesia on the actual day of surgery did (Fig. 1). No other significant differences were noted.

CONCLUSION

Local anaesthesia is the preferred mode of pain control for patients who express no strong preference for type of anaesthetic.

Relationship between outpatients' perceptions of physicians' communication styles and patients' anxiety levels in a Japanese oncology setting

For life-threatening illnesses such as cancer that require a long-term treatment regimen, communication is particularly important between doctors and patients. While it is assumed that the more serious the illness, the greater the need to relieve patients' anxiety, physicians' communication styles can directly influence patients' anxiety levels. The purpose of this study was to examine the relationship between outpatients' perceptions of physicians' communication styles and the patients' anxiety levels in oncology settings. Patient anxiety level was measured using the State Trait Anxiety Inventory before and after the consultation. The Perceived Physician's Communication Style Scale was developed in this study. Analysis of responses to the scale resulted in four factors--"acceptive", "patient-centered", "attentive", and "facilitative"--of the physician's communication style and explained 63.7% of the variance. The inter-correlation for overall scale items was 0.95. Patient satisfaction with the medical encounter was also measured to validate the physician's communication style scale. Moderate correlation between the physician's communication style and satisfaction was observed and confirms the relationship between a favorable communication style and a patient's satisfaction. After the consultation, the patients' anxiety levels dropped 5.0 +/- 1.5 points (p<0.001), and the physician's communication style was shown in many cases to be linked to patient anxiety levels after the consultation. The effect of the physician's communication style on patients' post-consultation anxiety levels was small among the patients with an advanced disease status. Also, the findings showed that patients' post-consultation anxiety levels remained low even among those patients with unfavorable examination results if the patients evaluated their physician's communication style as high. This study suggested that the physician's communication style is important not only for moderating patients' anxiety, but could also be helpful for moderating physicians' own stress levels when communicating bad news to patients.

Mental disturbances and perceived complexity of nursing care in medical inpatients: results from a European study

AIMS AND OBJECTIVES

The relationship between mental disturbances - anxiety and depression, somatization and alcohol abuse - on admission to internal medicine units and perceived complexity of care as indicated by the nurse at discharge was studied. The goal was to study the utility of short screeners for mental disturbances to select patients for case-management on admission.

DESIGN

The study had a cohort design: patients were included on admission and followed through their hospital stay until discharge. The study was conducted within the framework of the European Biomed 1 Risk Factor study. RESEARCH METHODS AND INSTRUMENTS: In the first 3 days of admission the patients were interviewed by a trained health care professional, who scored the SCL-8D, a somatization questionnaire based on the Whiteley-7 and the CAGE. At discharge, nurses rated the complexity of the patient's care.

RESULTS

Patients with high scores on anxiety and depression (SCL-8D) and on somatization received higher ratings on perceived nursing complexity than those with low scores, with and without control for age, severity of illness and chronicity. The actual nursing intensity and medical care utilization, as measured daily by means of a checklist, could not explain these relations. No differences were found between patients with high or low scores on alcohol abuse.

CONCLUSIONS

The study shows a potential use of screeners for mental disturbances to detect patients for whom nurses might need additional help. However, mental disturbance is not the sole criterion: functional status and other variables that predict medical and nursing care utilization should be included in a screening strategy for case-management programmes.

An investigation of psychological distress in patients who have been treated for head and neck cancer

There is now ample evidence that psychological distress is common in patients with head and neck cancer and that psychology has a role in reducing this distress. In this study, the prevalence, nature, and correlates of distress were investigated, in 18 patients who were no longer being actively treated but were attending a follow-up clinic or support group (n= 9 each). Four of the patients had appreciable psychological distress and four each had anxiety or depression of at least borderline importance. The degree of depression and distress decreased with increasing age and there were trends for depression to decrease with time after the onset of the illness and to be slightly less common among those attending the support group (2/9 compared to 4/9). Numerous psychosocial difficulties were reported and perceptions of support available from friends and family were mixed. There are implications for services, and in particular, patients need to be given clear information about the resources available to give them psychosocial support.

Functional status of patients with oral cancer and its relation to style of coping, social support and psychological status

Sixty-eight patients were evaluated 6 months to 6 years after treatment for oral cancer using standardized questionnaires to explore the influence of age, sex, site and stage of tumour, and primary treatment on their functional status measured by the University of Washington Quality of Life Questionnaire (UW-QoL), and the association between functional status and psychological outcome measured by the Hospital Anxiety and Depression Scale (HADS), style of coping measured by the Mental Adjustment to Cancer Questionnaire (MAC-Q), and social support measured by the Short-Form Social Support Questionnaire (SSQ-6). Young patients, women, patients with advanced tumours, those with oropharyngeal tumours and those who had been treated with both surgery and radiotherapy reported worse function. The worse the functional domain, the more likely it was to be associated with anxiety, depression and ineffective coping style, and better functional scores were weakly associated with fighting spirit, level of social support and satisfaction with that support. We have identified patients at need and highlighted their problems. Dealing with these problems may ultimately improve the perception of function after treatment of oral cancer.

Worry: daily self-report in clinical and non-clinical populations

The present study establishes an ecologically-valid point of reference for generalized anxiety disorder (GAD) treatment outcome studies. Although worry is the main diagnostic criterion for GAD, it is also a common and everyday cognition. Few studies have investigated the normal manifestation of worry in a non-clinical population. For this research, time spent worrying and the tendency to worry were measured in a non-clinical sample (n = 36), where GAD was screened-out, and results were compared to those obtained from a GAD sample (n = 60). Participants recorded the time spent worrying in self-monitoring notebooks for two consecutive weeks and completed the French version of the Penn State Worry Questionnaire (PSWQ). It was found that the non-GAD group reported less time spent worrying on a daily basis as well as a lower tendency to worry than the GAD group. Results are discussed in terms of treatment implications.

Inverse relationship between serotonin 5-HT(1A) receptor binding and anxiety: a [(11)C]WAY-100635 PET investigation in healthy volunteers

OBJECTIVE

The authors investigated the relationship between anxiety--a facet of the Revised NEO Personality Inventory dimension of neuroticism--and serotonin 5-HT(1A) receptor binding potential.

METHOD

Positron emission tomography with [(11)C]WAY-100635 was used to estimate regional 5-HT(1A) binding potential in 19 healthy volunteers who completed the Revised NEO Personality Inventory. Correlation coefficients were calculated to determine the degree of association between 5-HT(1A) binding potential and personality inventory measures.

RESULTS

There was a significant negative correlation between 5-HT(1A) binding potential and anxiety in four regions: the dorsolateral prefrontal cortex, anterior cingulate cortex, parietal cortex, and occipital cortex.

CONCLUSIONS

The inverse relationship between 5-HT(1A) receptor binding potential and anxiety is consistent with 1) animal models that have shown higher anxiety in mice lacking 5-HT(1A) receptors and 2) clinical trial data that have demonstrated antianxiety properties of partial 5-HT(1A) agonists.

Personality characteristics and accompanying symptoms in temporomandibular joint dysfunction, headache, and facial pain

AIMS

Patients with different facial pain/headache pathologies usually complain of numerous accompanying symptoms relative to systemic dysfunctions or to the patient's personality characteristics. The purpose of this work was: (1) to determine the prevalence of accompanying symptoms in groups of patients with temporomandibular joint (TMJ) dysfunction and other types of facial pain or headache disorders, (2) to assess the patients' personality characteristics and anxiety levels, and (3) to see whether significant differences were found between the groups.

METHODS

Two hundred forty-three patients were considered. They had TMJ intracapsular disorder (TMJ, n = 71), tension-type headache (TH, n = 52), migraine (M, n = 68), chronic daily headache (CDH, n = 26), or facial pain disorder as somatoform disorder (FP, n = 26). The presence of 23 symptoms was assessed; the Minnesota Multiphasic Personality Inventory (MMPI) and the Spielberger State and Trait Anxiety Inventory (STAI) were administered and the relative scores were calculated. Four different MMPI clusters (depressive, conversive, emotional, coper) were also considered. Intergroup differences were assessed by Chi-square analysis, 1-way analysis of variance, Bonferroni t test, and a logistic regression model and then standardized for gender and age, taking the tension-type headache group as a common reference group.

RESULTS

The TMJ group had: (1) a lower prevalence of almost all symptoms; (2) significantly lower scores of several MMPI and of state anxiety; and (3) odds ratio values < 1 for all symptoms except phobias and for emotional, conversive, and depressive MMPI profiles. The FP and CDH groups had the highest prevalence of the majority of symptoms and higher MMPI and STAI scale elevations.

CONCLUSION

It is concluded that some types of headache and facial pain seem to correlate with the presence of a number of accompanying symptoms and with some changes in personality. These changes are particularly relevant in patients with chronic daily headache and facial pain disorder. In contrast, patients with TMJ intracapsular disorders tended to show a low prevalence of accompanying symptoms and a normal personality profile.

Plasma and serum serotonin levels and their relationship to orofacial pain and anxiety in fibromyalgia

AIMS

Serum serotonin levels (S-5-HT) have been reported to be reduced in patients with fibromyalgia and to show a negative correlation with pain. We hypothesized that one mechanism behind this could be that platelets are activated to release 5-HT into the plasma compartment (P-5-HT), which then binds to nociceptors. The aims of this study were therefore to investigate the relation between P-5-HT and S-5-HT and their relationship versus orofacial pain and anxiety in fibromyalgia.

METHODS

Twelve patients with fibromyalgia, 12 patients with rheumatoid arthritis, and 12 healthy individuals participated in the study. Pain measures used were pain intensity assessed with a visual analog scale, pain drawings, and influence of pain on daily living activities (ADL). The Spielberger State and Trait Anxiety Inventory (STAI) scale was used for self-rating of anxiety levels. The participants were examined clinically, and the pressure pain threshold (PPT) over the masseter muscle was assessed. Finally, venous blood was collected for analysis of P-5-HT and S-5-HT.

RESULTS

The ratio between P-5-HT and S-5-HT was calculated to determine the relative plasma fraction of serotonin (RPS). Patients with fibromyalgia showed significantly lower S-5-HT than did patients with rheumatoid arthritis. They also showed significantly higher STAI scores and tender point index of orofacial muscles and significantly lower PPT than the healthy individuals. High RPS was associated with high ADL and STAI scores.

CONCLUSION

This study indicates that a high level of plasma serotonin in relation to serum level is associated with pain discomfort and increased anxiety in fibromyalgia.

Comparison of anxiety assessments between clinicians and patients with acute myocardial infarction in cardiac critical care units

BACKGROUND

Although anxiety is common after acute myocardial infarction and can adversely affect physical recovery, it is not part of the routine clinical assessment of patients with myocardial infarction. Furthermore, evidence suggests that patients and clinicians differ significantly in their assessments of patients' anxiety levels.

OBJECTIVES

To determine the extent to which clinicians assess anxiety in patients with acute myocardial infarction and to compare patients' self-ratings with their clinicians' assessments.

METHODS

In a prospective, descriptive study, 101 patients used the Spielberger State Anxiety Index to assess their anxiety during the first 48 hours after admission for acute myocardial infarction. Patients' scores were compared with nurses' and physicians' assessments of the patients' anxiety as reported in the medical record.

RESULTS

Only 45 patients (45%) had anxiety assessments noted in the record. Of those 45, 26 patients (58%) were described simply as anxious without any further description of the level of anxiety. Eleven (24%) of those 45 patients had behaviors of anxiety recorded, again without any indication of the level of anxiety. No association between patients' self-assessments and their clinicians' assessments was apparent (lambda = .03; P > .05).

CONCLUSIONS

Anxiety was not routinely assessed, despite nearly half the patients reporting moderate to extreme anxiety when asked. When clinicians assessed anxiety, their assessments did not match patients' self-ratings of anxiety. A simple, easy-to-use instrument for discriminating levels of anxiety is needed.

Factors associated with Army obstetricians-gynecologists' practice of HIV prevention education during routine gynecologic care

The authors evaluate obstetricians-gynecologists' (OB-GYNs') anxiety about clinical uncertainty and patient, physician, and organizational factors associated with their selection of HIV-related educational activities for high-risk and low-risk written case simulations. A total of 117 U.S. Army OB-GYNs completed a mailed, anonymous questionnaire. Overall, informants were much less likely to educate in response to the low-risk simulation; however, more informants who were anxious about uncertainty were more likely to do so in a model that included supportive institutional policies, willingness to educate despite patient barriers, and comfort with the topic. OB-GYNs were more likely to educate in response to the high-risk simulation given greater willingness to discuss HIV despite organizational barriers, supportive policies, and comfort. Findings suggest a need to better understand the role that anxiety about uncertainty plays in HIV prevention and the need to promote organizational policies that support and remove barriers to clinically based education.

Different cleft conditions, facial appearance, and speech: relationship to psychological variables

OBJECTIVE

The purpose of this investigation was to study the adjustment and learning characteristics of children with different types of clefts. The hypotheses were that there may be different relationships among cleft variables (speech and appearance) according to the cleft types.

DESIGN

The study compared three cleft groups on behavior rating, anxiety scales, depression scales, and self-perception (analyses of variance) and examined the influence of facial and speech ratings on self-perception (multiple regression analyses).

SETTING

All patients were treated at a university hospital cleft palate clinic.

PATIENTS

Sixty-five children aged 8 years to 17 years were selected based on nonsyndromic cleft (unilateral cleft lip and palate [ULP], bilateral cleft lip and palate [BLP], and cleft palate only [CPO]) and no significant neurological condition or hearing loss.

RESULTS

The findings indicated children with CPO showed greater problems with parent- and teacher-reported depression, anxiety, and learning related to speech than children with ULP or BLP. The later two groups showed fewer problems and a greater relationship of problem to facial appearance. The children with ULP self-reported lower levels of depression than the other two groups.

CONCLUSIONS

Children with cleft show relatively good overall adjustment, but some problems appear related to speech and facial appearance. Subgroups may need to be studied separately.

Assessment of parents' concerns and evaluation of outcomes

BACKGROUND

Clinical and service evaluation often fails to accommodate sufficiently to parental perspectives and priorities concerning health interventions. Although parent satisfaction questionnaires are widely used, these assess issues chosen by the researcher. Quality of life research methods, however, can assess individual priorities.

METHODS

A Schedule for Evaluation of Quality of Life was adapted to record the nature, and relative importance of parental concerns about their child before child psychiatric hospital admission. Level of concern or worry was assessed pre- and post-admission, and at 1 year follow-up, with a waiting-list control. Data were analysed qualitatively and quantitatively for individuals and groups of cases.

RESULTS

The adapted instrument was feasible and clinically useful. It did not show repeated measurement effects but was sensitive to the effects of intervention (hospital admission). Effects (reduction in levels of concern) remained evident at 1 year follow-up.

CONCLUSION

The instrument is brief, non-intrusive, and sensitive to change. It has utility for clinical case evaluation. It may complement satisfaction questionnaires, and has advantages over rating scales for the evaluation of treatment outcomes.

Five-year prospective study of the effects of anxiety and depression in patients with coronary artery disease

Anxiety and depression have significant and widespread effects on daily function and symptoms of patients with coronary artery disease over a 5-year period. This may partially explain why results of treadmill stress testing and angiography poorly predict the daily functioning of patients with coronary artery disease.

Interaction of psychological type and anxiety sensitivity on academic achievement

The Myers-Briggs Type Indicator and the Anxiety Sensitivity Index were administered to 143 undergraduate college students. Analyses of variance were performed to assess the relationship between these indices and semester grades (Grade Point Average). The Myers-Briggs Sensing-Intuitive and Judging-Perceiving dimensions showed significant main effects on GPA. The interaction of Judging-Perceiving and Anxiety Sensitivity was also significant (F = 18.00, p<.0001), although that of Sensing-Intuition and Anxiety Sensitivity was not (F = 3.51, p=.06). These findings suggest that personality factors measured by the Myers-Briggs Type Indicator may serve as mediating variables in evaluating whether trait anxiety has a facilitating or debilitating effect on academic achievement.

Patterns of anxious arousal during exposure to feared situations in individuals with social phobia

Behavioral assessment tests (BATs) are commonly used in studies of social phobia (SP). While previous studies have examined subjective anxiety during BATs, they have usually reported only mean or peak ratings. The current study examined whether there are different patterns of anxious arousal in anticipation of, and during exposure to, feared situations among individuals seeking treatment for SP (N = 153). A four cluster solution was judged to best describe the data, and the four clusters were labeled 'high anxiety,' 'increasing/high anxiety', 'moderate anxiety' and 'mild anxiety'. Before treatment, the cluster groups did not differ on person characteristics, subtype of social phobia, or levels of depressive symptoms. However, they did differ in terms of the severity of social phobia symptoms and the emotional valence of thoughts reported at the conclusion of the BAT. While members of all clusters benefited from cognitive-behavioral group therapy for social phobia, the clusters showed some differential response in amount of symptom reduction and likelihood of continuing to meet diagnostic criteria following treatment. The different emotional experiences of clients in the various clusters are explored and implications for cognitive-behavioral therapy are proposed. Finally, limitations of this study and future directions are discussed.

The neurobiology of anxiety disorders: implications for psychiatric nursing practice

This era of neurobiological advances challenges psychiatric nurses to develop innovative practice models that address the needs of clients with anxiety disorders. Technological discoveries and molecular and genetic research provide a wealth of evidence-based data that serve as the basis of symptom management, prevention, and health promotion and maintenance in clients experiencing anxiety disorders. This article provides an overview of current data-based studies and conceptual models of various anxiety disorders and their key components. Underpinnings include the interrelationship among neurotransmitter systems, neuroendocrinological processes, and neuroanatomical structures and their role in mediating stress, normal anxiety, and various anxiety disorders. Treatment considerations are also an integral part of this article. The discussion of pharmacologic and nonpharmacological interventions reflect dysregulation of intricate neurobiologic processes and concurrent behaviors and individual client needs.

Does the individual zones of optimal functioning model discriminate between successful and less successful athletes? A meta-analysis

According to the individual zones of optimal functioning (IZOF) model, an athlete's performance is successful when his or her pre-competition anxiety is within or near the individually optimal zone. When anxiety falls outside the optimal zone, performance deteriorates. The model also suggests that skilled athletes are aware of, and are able to accurately recall and anticipate, their pre-competition anxiety. A meta-analysis of 19 studies from 1978 to 1997 (146 effect sizes based on 6387 participants) was conducted to examine the validity of the assumptions regarding the in-out of the zone notion and the accuracy of recalls and anticipatory measures of anxiety. The findings provide fairly good empirical support for the IZOF anxiety model, with an overall effect size (d) for the in-out of the zone notion of d = +0.44 (41 effect sizes, n = 3175). In other words, the performance of athletes who were within their individually optimal zones were almost one-half a standard deviation unit better than that of athletes who were outside their zones. Furthermore, both effect sizes (r(w)) for accuracy of precompetition anxiety measures, recall (r(w) = +0.71, 24 effect sizes, n = 369) and anticipatory (r(w) = +0.69, 81 effect sizes, n = 2843), exceeded the 'large effect' suggested for correlations by Cohen. The implications for future research extending the IZOF model to a wider range of positive and negative emotions are discussed.

Response patterns to repeated CO2 inhalation in individuals with high anxiety sensitivity

The present report extends previous work which has documented two distinct response patterns to repeated presentation of interoceptive cues (using CO2 inhalation) in PD patients [Beck, J. G. & Shipherd, J. C. (1997). Repeated exposure to interoceptive cues: does habituation of fear occur in panic disorder patients? Behaviour Research and Therapy, 35, 551-557]. We were interested in determining if these two patterns of fear habituation and sensitization would be noted in panic-naive individuals who reported high levels of Anxiety Sensitivity. A second aspect of this report examined whether attention to bodily sensations versus to neutral material would impact fear habituation and sensitization. Participants included 43 panic-naive individuals who scored at least 1 standard deviation above norms on the Anxiety Sensitivity Index. Results indicated that 37% of the sample reported habituation of fear, 47% reported fear sensitization and 16% demonstrated relatively stable fear levels across 12 inhalations of CO2 during session 1. The attentional manipulation did not exert a pronounced influence on anxiety, panic symptom severity, skin conductance, or heart rate in either Habituators or Sensitizers during session 2. These results are discussed in light of their relevance in understanding fundamental psychopathological processes underlying Panic Disorder.