The role of safety behaviors in exposure-based treatment for panic disorder and agoraphobia: associations to symptom severity, treatment course, and outcome

The potentially detrimental effects of safety behaviors during exposure therapy are still subject to debate. Empirical findings are inconsistent, and few studies have investigated effects of idiosyncratic safety behavior manifestations during exposure or in everyday life. These limitations might be due to a lack of appropriate measures that address individual safety behaviors. We examined psychometric properties and predictive value of the Texas Safety Maneuver Scale (TSMS), a questionnaire specifically targeting safety behaviors in panic disorder and agoraphobia. Effects of safety behavior use, both during everyday life and during therapy, were examined using data from a multicenter RCT of N=268 patients that aimed at evaluating efficacy and mechanisms of action of two variants of an exposure-based therapy. The TSMS total score demonstrated good internal consistency (α=0.89), and it showed significant correlations with selected measures of baseline anxiety and impairment. The proposed factor structure could not be replicated. Frequent safety behavior use at baseline was associated with actual safety behavior during exposure exercises. Pronounced in-situ safety behavior, but not baseline safety behavior was associated to detrimental treatment outcome. The results underline the relevance of a rigorous safety behavior assessment in therapy. The actual relationship between safety behavior use and treatment outcome is yet to determine.

Prevalence and Behavioral Styles of Fear of Flying

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), fear of flying is a specific situational phobia, but it has a heterogeneous character because it can be influenced by many other fears. Attention toward (monitoring) or away from (blunting) threatening information is influenced by people’s control of voluntary attention. In our online questionnaire study, 9,166 subjects (age 17–70 years) were selected for participation. The Flight Anxiety Modality (FAM) questionnaire and Miller Behavioral Style Scale (MBSS) were used to measure fear of flying and behavioral style. Also, demographic information was collected. Women reported a higher FAM sum score than men, as predicted. Participants who scored higher on the MBSS were found to have also scored higher on the FAM. Participants who had never flown before scored higher on the FAM than participants who had flown before. In this sample, monitoring can be associated with an increase in fear of flying. Future research should focus on gaining a more multicultural picture of fear of flying.

Angstbezogenes Kontrollerleben

Theoretischer Hintergrund: Subjektive Kontrollüberzeugungen werden als wesentlicher Faktor in der Entstehung und Aufrechterhaltung von Angststörungen diskutiert. Der Angstkontrollfragebogen (AKF) stellt das einzige Verfahren dar, das auf die Erfassung angstspezifischer Kontrollüberzeugungen zielt. Fragestellung: Wie ist die psychometrische Güte einer deutschen Übersetzung des AKF zu beurteilen? Methode: Untersuchung des AKF in einer nicht-klinischen und einer klinischen Stichprobe. Ergebnisse: Der AKF Gesamtscore wies befriedigende Reliabilitätskennwerte auf; darüber hinaus wurden Hinweise auf konvergente Validität gefunden. Allerdings stellen die Ergebnisse die Spezifität des Verfahrens für Angsterleben in Frage. Wie bereits in Studien zur Originalversion konnte keine überzeugende Faktorenstruktur etabliert werden. Schlussfolgerungen: Der AKF stellt eine potentiell wichtige Ergänzung nicht-symptomspezifischer Maße zur Erklärung von Psychopathologie dar, bedarf jedoch insbesondere hinsichtlich seiner latenten Struktur weiterer Überprüfung.

[ADHD across the lifespan - an update on research and practice]

ADHD can be regarded as a lifespan disorder. From biopsychosocial vantage point, ADHD leads to age-specific impairments, high psychological distress and is associated with a high occurrence of comorbid disorders. For this review, we summarize actual findings from epidemiological, neuroscientific and clinical studies to present an overview of ADHD-research. We discuss the proposed revisions for DSM-V criteria by comparing them with the present DSM-IV-TR criteria, with a focus on the implications for research and practice. In the second part of this paper, we present new findings from socioeconomic, diagnostic and therapeutic perspectives. There is evidence for a high economic burden that is indirectly caused by ADHD (e.g., production loss, material costs, higher accident rates). Consequently, there is a high demand for comprehensive diagnostic and therapeutic approaches. We present a summary of the latest available diagnostic instruments and therapeutic manuals. The results of research and practice show a growing support for a lifespan perspective on ADHD psychopathology. The burdens resulting from ADHD are evident in all age groups, which has led to establishing age-specific diagnostic and therapeutic materials. Although there is a lack in ADHD-specific healthcare in adulthood, this should be realized by structural changes in healthcare services.