The triple response approach to assessment: a conceptual and methodological reappraisal

Cognitive style: a psycholexically‐derived personality‐centred model

Cognitive style suffers from a confusing multitude of conceptualizations, and dominance by information‐processing type measures. This study sought to elucidate a comprehensive and universal set of personality‐centred cognitive style constructs. A grounded approach based on the psycholexical hypothesis (effective in personality modelling) was adapted, explicating cognitive styles as evident in late adolescents. Approximately 700 Australian secondary teachers generated a lexicon of 1040 style adjectives, which were consolidated into 99 key words. 596 teachers rated 1192 senior secondary students against these. After removing acquiescence and a ubiquitous good–bad‐ability factor, optimum structure appears to be a spherex abridgeable as three circumplexes, reported across six factor pure and 24 blended facets. Copyright © 2003 John Wiley & Sons, Ltd.

Creating a Computerized Instrument for the Assessment of Blood-Injury-Injection Phobia

A new computerized instrument (the Multimedia Behavioral Avoidance Test, or MBAT) for blood-injury-injection phobia (BII) assessment is presented. Analogous stimuli such as images and videos can also elicit anxiety responses; thus, they can be used for the assessment of phobia. The MBAT was applied to participants via computer, and subjective anxiety responses and time latency were recorded. The MBAT was composed of 30 original images and 30 videos related to blood, injury and injections. The MBAT was compared with other pencil-and-paper questionnaires for BII phobia, and heart rate was also measured with a pulsioximeter. The participants included 160 students and professionals (34.5% males, 65.6% females; mean 28.6 years old). The results showed a high reliability for internal consistency in images and videos (α = .98 both), with a single factor that groups all the items. In addition, the MBAT had high concurrent validity (r = .78 to .85) with the different anxiety scales compared. The MBAT diagnosed 12 participants with possible BII phobia. It is a useful instrument in the assessment of this kind of phobia because it is easier and quicker than pencil-and-paper questionnaires, it uses more objective measurements, and it is useful in planning subsequent exposure with images and videos.

Self-management programmes for COPD: moving forward

Self-management is of increasing importance in chronic obstructive pulmonary disease (COPD) management. However, there is confusion over what processes are involved, how the value of self-management should be determined, and about the research priorities. To gain more insight into and agreement about the content of programmes, outcomes, and future directions of COPD self-management, a group of interested researchers and physicians, all of whom had previously published on this subject and who had previously collaborated on other projects, convened a workshop. This article summarises their initial findings. Self-management programmes aim at structural behaviour change to sustain treatment effects after programmes have been completed. The programmes should include techniques aimed at behavioural change, be tailored individually, take the patient's perspective into account, and may vary with the course of the patient's disease and co-morbidities. Assessment should include process variables. This report is a step towards greater conformity in the field of self-management. To enhance clarity regarding effectiveness, future studies should clearly describe their intervention, be properly designed and powered, and include outcomes that focus more on the acquisition and practice of new skills. In this way more evidence and a better comprehension on self-management programmes will be obtained, and more specific formulation of guidelines on self-management made possible.

The effects of acceptance versus control contexts on avoidance of panic-related symptoms

The present study compared the effects of creating an acceptance versus a control treatment context on the avoidance of aversive interoceptive stimulation. Sixty high anxiety sensitive females were exposed to two 10-min periods of 10% carbon dioxide enriched air, an anxiogenic stimulus. Before each inhalation period, participants underwent a training procedure aimed at encouraging them either to mindfully observe (acceptance context) or to control symptoms via diaphragmatic breathing (control context). A third group was given no particular training or instructions. We hypothesized that an acceptance rather than control context would be more useful in the reduction of anxious avoidance. Compared to control context and no-instruction participants, acceptance context participants were less avoidant behaviorally and reported less intense fear and cognitive symptoms and fewer catastrophic thoughts during the CO(2) inhalations. We discuss the implications of our findings for an acceptance-focused vs. control-focused context when conducting clinical interventions for panic and other anxiety disorders.

Heart-focused anxiety and chest pain in postangiography medical patients

The present cross-sectional study sought to examine the extent to which heart-focused anxiety is associated with the co-occurrence of coronary artery disease (CAD) and a history of regular smoking in a sample of 148 postangiography patients from a cardiology unit. Individuals with CAD who regularly smoked demonstrated significantly greater heart-focused attention, but no greater degree of avoidance and fear of heart-focused sensations, than did nonsmoking persons with CAD and smokers without CAD. We also found evidence that heart-focused attention and fear incrementally predicted (above and beyond demographic variables and body mass index) intensity of average chest pain. Overall, this study provides some of the first empirical evidence that the occurrence of regular smoking and CAD is associated with specific dimensions of health anxiety. We discuss these findings in relation to models of panic pathology and anxious responding to bodily sensations.

The relations of anxiety sensitivity, experiential avoidance, and alexithymic coping to young adults' motivations for drinking

The authors examined whether motivations for drinking alcohol are associated with the anxiety-related dispositional tendencies of anxiety sensitivity, experiential avoidance, and alexithymic coping. The authors administered the Anxiety Sensitivity Index, Experiential Avoidance Scale, 20-item Toronto Alexithymia Scale, Revised Drinking Motives Questionnaire, and a demographics questionnaire to 182 university drinkers. In multiple regressions, the dispositional factors significantly predicted the risky drinking motives of coping, enhancement, and conformity. Coping and enhancement motives were significantly predicted by experiential avoidance. Conformity motives were significantly and independently predicted by anxiety sensitivity and alexithymia. The process of experiential avoidance mediated the bivariate correlation between anxiety sensitivity and coping-motivated drinking to a greater extent than did the process of alexithymic coping. The authors discuss the observed relations in regard to the psychological functions of drinking behavior that may portend the development of heavy drinking and alcohol problems in dispositionally vulnerable individuals. They also review implications for refinements of behavior therapy for problem drinkers.

Anxiety sensitivity in the prediction of pain-related fear and anxiety in a heterogeneous chronic pain population

The present study evaluated anxiety sensitivity, along with depression and pain severity, as predictors of pain-related fear and anxiety in a heterogeneous chronic pain population (n=68). The results indicated that the global anxiety sensitivity factor, as indexed by the Anxiety Sensitivity Index (ASI: Reiss, Peterson, Gursky & McNally, 1986: Reiss, S., Peterson, R. A., Gursky, M. & McNally, R. J. (1986). Anxiety, sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8) total score, was a better predictor of fear of and anxiety about pain relative to the other relevant variables. Additionally, the physical concerns subscale of the ASI was a better predictor of pain-related fear dimensions characterized by high degrees of physiological symptoms and behavioral activation on both the Fear of Pain Questionnaire-III (FPQ-III; McNeil & Rainwater, 1998: McNeil, D. W. & Rainwater, A. J. (1998). Development of the Fear of Pain Questionnaire-III. Journal of Behavioral Medicine.) and Pain Anxiety Symptoms Scale (PASS; McCracken, Zayfert & Gross, 1992: McCracken, L. M., Zayfert, C. & Gross, R. T. (1992). The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain. Pain, 50, 67-73). In a related way, the ASI psychological concerns subscale was a better predictor of pain-related anxiety dimensions characterized by cognitive symptoms of anxiety. Overall, these findings reiterate the importance of anxiety sensitivity in understanding pain-related fear and anxiety, and suggest anxious and fearful responding can be predicted more accurately with higher levels of correspondence between a particular anxiety sensitivity domain and events that closely match that fear.

Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War veterans: a prospective analysis

The authors examined the relationship over time of posttraumatic stress disorder (PTSD) and depression symptoms in a sample of Gulf War veterans. A large sample (N = 2,949) of Gulf War veterans was assessed immediately following their return from the Gulf region and 18-24 months later. Participants completed a number of self-report questionnaires including the Mississippi Scale for Combat-Related PTSD (T. M. Keane, J. M. Caddell, & K. L. Taylor, 1988) and the Brief Symptom Inventory (L. R. Derogatis & N. Melisaratos, 1983) at both time points and an extended and updated version of the Laufer Combat Scale (M. Gallops, R. S. Laufer, & T. Yager, 1981) at the initial assessment. A latent-variable, cross-lag panel model found evidence for a reciprocal relation between PTSD and Depression. Follow-up models examining reexperiencing, avoidance-numbing, and hyperarousal symptoms separately showed that for reexperiencing and avoidance-numbing symptoms, the overall reciprocal relation held. For hyperarousal symptoms, however, the association was from early hyperarousal to later depression symptoms only.

Psychophysiological assessment: clinical applications for PTSD

Descriptions of anxiety disorders clearly recognize the physiological features of anxiety, yet in most clinical practice and research there is little actual use of physiological measurement. This is unfortunate because a potentially important source of information is thereby unavailable and is likely to result in judgements about emotional experience that are less accurate, complete, and reliable than those that include physiological information. The neglect of physiological measures may result from a variety of concerns regarding test attributes such as reliability, validity, utility, and complexity. Promising results from studies of posttraumatic stress disorder (PTSD) demonstrate that physiological assessment can provide valuable clinical and theoretical insight. Numerous studies have now shown that heightened physiological reactivity to trauma-related cues is highly indicative of a diagnosis of PTSD. Physiological tests have achieved some success in predicting the development and persistence of PTSD, and in predicting and assessing treatment response. Studies of the startle response, aversive conditioning, and brain potentials during cognitive processing have identified several potentially important differences between PTSD patients and controls. This paper provides an overview of psychophysiological findings in PTSD and considers potential clinical applications of psychophysiological assessment for this disorder.

Development of the Fear of Pain Questionnaire--III

Fear and/or anxiety about pain is a useful construct, in both theoretical and clinical terms. This article describes the development and refinement of the Fear of Pain Questionnaire (FPQ), which exists in its most current form as the FPQ-III. Factor analytic refinement resulted in a 30-item FPQ-III which consists of Severe Pain, Minor Pain, and Medical Pain subscales. Internal consistency and test-retest reliability of the FPQ-III were found to be good. Four studies are presented, including normative data for samples of inpatient chronic pain patients, general medical outpatients, and unselected undergraduates. High fear of pain individuals had greater avoidance/escape from a pain-relevant Behavioral Avoidance Test with Video, relative to their low fear counterparts, suggesting predictive validity. Chronic pain patients reported the greatest fear of severe pain. Directions for future research with the FPQ-III are discussed, along with general comments about the relation of fear and anxiety to pain.

Physical activity in chronic fatigue syndrome: assessment and its role in fatigue

This paper describes the assessment of physical activity in chronic fatigue syndrome (CFS) and investigated the following questions: Do patients with CFS have low levels of physical activity; is there a relationship between actual level of physical activity and fatigue; can self-report measures adequately assess actual level of physical activity; what is the role of cognitions with respect to physical activity; and are results with respect to physical activity specific to CFS? Three different types of activity measures were used: self-report questionnaires, a 12-day self-observation list, and a motion-sensing device (Actometer) which was used as a reference for actual activity level. Fifty-one patients with CFS, 50 fatigued patients with multiple sclerosis (MS), and 53 healthy subjects participated in this study. Although none of the self-report questionnaires showed high correlations with the Actometer, questionnaires that require simple ratings of specified activities were related to the Actometer and can be used as acceptable substitutes, in contrast to instruments that require general subjective interpretations of activity that had low or non-significant correlations with the Actometer. Actometer results showed that CFS patients and MS patients had similar activity levels and both groups were significantly less active than healthy subjects. Compared to MS patients, CFS patients were more likely to indicate that they had been less active than other persons they knew. Activities which patients expected to result in higher fatigue levels were less frequently performed. Patients with CFS had significantly higher scores on this measure than MS patients and healthy subjects. Low levels of physical activity were related to severe fatigue in CFS but not in MS. In conclusion, although CFS patients have similar low activity levels than MS patients, there are also important differences between both groups: in CFS cognitive factors are more prominently involved in producing the low activity levels than in MS and in CFS patients activity level is related to fatigue but not in MS.

Disgust as the source of false positive effects in the measurement of ophidiophobia

Why many people who self-report high levels of fear on the Snake Anxiety Questionnaire (SNAQ; Klorman, Weerts, Hastings, Melamed, & Lang, 1974) do not show subsequent behavioral fear was investigated. Fear and disgust among 70 female under-graduates were assessed by self-report, behavioral ratings, and behavioral approach measures. The results suggest that the observed discordance occurs because the SNAQ is strongly confounded by the emotion of disgust.

"Cleaning-up cognition" in triple-response fear assessment through individualized functional behavior analysis

Improvements in behavioral assessment spurred by the triple-response concept have been overshadowed by a preoccupation with content of assessment and a lack of regard for the context of assessment. The aims of this article are to (a) clarify the imprecise use of the verbal-subjective-cognitive mode and to reinterpret cognitive events based on evidence and methods derived from clinical behavior analysis, (b) discuss the limitations of the triple-response assessment framework, and (c) suggest an alternative functional idiographic approach to assessment and treatment that may direct attention toward behavior relations understood functionally within the context of environmental contingencies; an approach that once was the hallmark of behavior therapy and the basis for therapeutic interventions.

Dimensional assessment of chronic fatigue syndrome

The absence of laboratory tests and clear criteria to identify homogeneous (sub)groups in patients presenting with unexplained fatigue, and to assess clinical status and disability in these patients, calls for further assessment methods. In the present study, a multi-dimensional approach to the assessment of chronic fatigue syndrome (CFS) is evaluated. Two-hundred and ninety-eight patients with CFS completed a set of postal questionnaires that assessed the behavioural, emotional, social, and cognitive aspects of CFS. By means of statistical analyses nine relatively independent dimensions of CFS were identified along which CFS-assessment and CFS-research can be directed. These dimensions were named: psychological well-being, functional impairment in daily life, sleep disturbances, avoidance of physical activity, neuropsychological impairment, causal attributions related to the complaints, social functioning, self-efficacy expectations, and subjective experience of the personal situation. A description of the study sample on these dimensions is presented.