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Biomedical subjects

M G Craske

Publications and source records attributed to M G Craske.

At least 19 recordsLinked to original sources
PubMed2001

Functional MRI changes during panic anticipation and imagery exposure.

While undergoing fMRI, six patients with DSM IV diagnosis of panic disorder and six normal controls performed directed imagery of neutral, moderate and high anxiety situations based on an individually determined behavioral hierarchy. Brain activity was compared during high vs neutral anxiety blocks for each group of subjects using SPM99b. Panic patients showed increased activity in inferior frontal cortex, hippocampus and throughout the cingulate both anterior and posterior, extending into the orbitofrontal cortex and encompassing both hemispheres. These areas may constitute the important circuit in the psychopathology of panic disorder. We propose that this pattern of activity may enhance the encoding and retrieval of strong emotional events, facilitating the recapitulation of traumatic experiences and leading to panic disorder in vulnerable individuals.

Adult↗
PubMed2001

Reactivity to interoceptive cues in nocturnal panic.

In this study, patients with panic disorder (PD) who suffered nocturnal panic (NP) attacks were compared with PD patients who never experienced NP attacks and healthy controls. Three tasks were chosen to evaluate attention to cardiac cues, reactivity to induction of respiratory cues, and reactivity to relaxation cues. Relative to healthy controls, PD groups reported more fear of all three tasks and showed more physiological arousal in response to the hyperventilation task. The only task on which the two PD groups differed was the relaxation task, where nocturnal panickers were significantly more distressed. These findings are consistent with the notion that nocturnal panickers are fearful of states involving a diminution of conscious awareness or vigilance.

Agoraphobia↗
PubMed2001

A longitudinal study of the etiology of separation anxiety.

A longitudinal examination of the relation between separation experiences and the development of separation anxiety at age 3, 11 and 18 years was conducted. Three associative pathways were assessed. Conditioning events were not related to separation anxiety at age 3. Vicarious learning (modelling) in middle childhood (age 9 years) was the conditioning variable most strongly related to separation anxiety at age 11, accounting for 1.8% of the variance in symptoms. Separation experiences (hospitalisations) before the age of 9 were inversely correlated with separation anxiety at age 18. That is, more overnight hospital stays in childhood were related to less separation anxiety in late adolescence. However, none of these conditioning correlates remained significant predictors of separation anxiety in adjusted regression models. In contrast, certain "planned" separations in early-mid childhood were associated with lower levels of separation anxiety at later ages. Generally, the findings were consistent with predictions from the non-associative theory of fear acquisition. That vicarious learning processes appeared to modulate, albeit to a minor degree, the expression of separation anxiety during mid-late childhood suggests that there may be critical periods during which some individuals are susceptible to the interactive effects of both associative and non-associative processes. These findings serve to illustrate the complexity of fear acquisition, the relevance of developmental factors and the likely interplay between associative and non-associative processes in the etiology of fear and anxiety.

Adolescent↗
PubMed2001

Failure to overcome 'innate' fear: a developmental test of the non-associative model of fear acquisition.

The non-associative, Darwinian theory of fear acquisition proposes that some individuals fail to overcome biologically-relevant fears (e.g. height) because they (1) do not have sufficient safe exposure to the relevant stimuli early in life or (2) are poor habituators who have difficulty 'learning not to fear'. These two hypotheses were tested in a longitudinal birth cohort study. Study 1 found evidence for reduced exposure to height stimuli in childhood for individuals with a fear of heights compared to study members without fear. Study 2 found evidence for higher levels of stress reactivity (a proxy for habituation) in childhood and adolescence among 18-year-old height phobics compared to study members with dental phobia and those with no fear. The results were discussed in relation to recent findings suggesting that some evolutionary-relevant fears may appear in the absence of traumatic 'learning' experiences. The merits of adding a fourth, non-associative pathway to Rachman's [Rachman, S. (1977)]. The conditioning theory of fear acquisition: a critical examination. Behaviour Research and Therapy, 15, 375-387) three pathways model of fear acquisition were briefly considered.

Adolescent↗
PubMed2001

Cognitive theories of generalized anxiety disorder.

The hallmark feature of generalized anxiety disorder, worry, has been hypothesized to be a key factor in the production of threat-related information-processing biases in the domains of attention, memory, interpretation of ambiguity, and problem solving; however, worry and cognitive biases are not unique to generalized anxiety disorder. What may be unique to generalized anxiety disorder is the pervasive use of worry as a strategy to avoid intense negative effect and the broad domains in which these biases are exhibited, directly relating to the clinical observation that patients with generalized anxiety disorder worry about numerous life stressors. Also, the authors conclude that information-processing biases contribute to worry but that they are insufficient for the development of generalized anxiety disorder. Directions for future research and clinical implications are discussed.

Anxiety Disorders↗
PubMed2001

Issues of measurement and mechanism in meta-analyses: comment on Westen and Morrison (2001).

The authors suggest that D. Westen and K. Morrison's (2001) meta-analysis of treatment is critically limited in the consideration of measurement and mechanisms of therapeutic change. The measures included in the analysis fail to represent a comprehensive coverage of the domains within which change is expected. Moreover, they do not measure the theoretically derived constructs currently conceived as being central to each disorder. Further, the particular meta-analytical approach taken prohibits evaluation of the treatment components responsible for change. The authors reviewed the most recent data on comorbidity as an issue of treatment efficacy and generalizability, proffer an interpretation for the difference in outcome results across the 3 diagnostic groups, and discuss internally valid methodologies for the bridging from research to clinical practice.

Anxiety Disorders↗
PubMed2001

Paths to panic disorder/agoraphobia: an exploratory analysis from age 3 to 21 in an unselected birth cohort.

OBJECTIVE: To evaluate childhood temperamental traits and early illness experiences in the etiology of adult panic disorder with agoraphobia. METHOD: Evaluated temperamental and illness experience factors, at ages 3 through 18, as predictors of panic and agoraphobia at ages 18 or 21 in an unselected sample (N = 992). Analyses were conducted with classification trees. RESULTS: Experience with respiratory ill health predicted panic/agoraphobia relative to other anxiety disorders and healthy controls. Also, temperamental emotional reactivity at age 3 predicted panic/agoraphobia in males but did not predict other anxiety disorders, compared with healthy controls. Furthermore, temperament and ill health interacted with gender. CONCLUSIONS: Results are discussed in terms of cognitive theories of fear of physical symptoms and biological models of respiratory disturbance for panic/agoraphobia.

Adolescent↗
PubMed2001

Cognitive biases in anxiety disorders and their effect on cognitive-behavioral treatment.

Cognitive theorists hypothesize that cognitive biases are a major component in the development and maintenance of anxiety disorders. These include attentional biases toward threat-related information, distorted judgments of risk, and selective memory processing. The empirical evidence for these cognitive biases in anxiety disorder populations is reviewed. Potential deleterious effects of these biases on the process of cognitive-behavioral therapy are also discussed, as are possible ways of overriding those effects and maximizing treatment efficacy.

Anxiety Disorders↗
PubMed2000

Verbalization and imagery during worry activity.

This study examined a model of worry as verbal activity that suppresses imagery and autonomic fear. The effects of emotional imagery vs. verbalization upon worry and fearfulness of an impending public speaking situation were assessed in 54 public speaking anxious participants who were categorized as worriers. Randomly assigned groups that processed the impending public speaking task either verbally or imaginally were compared to a group that received no processing instructions. Subjective distress was measured throughout the study. Results revealed partial support for the hypotheses that proportions of verbal thought and imagery shift upon threat presentation and a mitigation of fear habituation with verbalization. However, interpretation of between-group differences was complicated because the groups did not report consistent or complete adherence to cognitive processing instructions. Methodological and design implications for future investigations in this area are discussed.

Adolescent↗
PubMed2000

Manipulations of exposure-based therapy to reduce return of fear: a replication.

Using exposure-based treatment for fear of heights, we tested two different manipulations, namely administering blocks of exposure trials on an expanding spaced schedule and varying the nature of the exposure, both of which have been shown to reduce return of fear [Rowe, M. K., & Craske, M. G. (1998a). Effects of an expanding-spaced versus massed exposure schedule on fear reduction and return of fear. Behaviour Research and Therapy, 36, 701-718; Rowe, M. K., & Craske, M. G. (1998b). Effects of varied-stimulus exposure training on fear reduction and return of fear. Behaviour Research and Therapy, 36, 719-734.]. The samples for these two studies included 23 and 34 undergraduates, respectively. Fear was assessed before, immediately after and one month after treatment using self-report and physiological measures. Study hypotheses were not strongly supported, but the manipulations did lead to different responses during treatment. The data suggest that physiological habituation is not necessary for fear reduction. Expanding spaced treatment may have increased generalization, and those in the constant and varied conditions responded to different aspects of the exposure. Reasons for the failure to replicate previous research and ideas for future research are discussed.

Adult↗
PubMed2000

Dishabituation processes in height fear and dental fear: an indirect test of the non-associative model of fear acquisition.

The fear dishabituation hypothesis described in the non-associative model of fear acquisition was tested in a longitudinal birth cohort study. Results were consistent with height fear and phobia dishabituation. That is, 're-emergence' of a fear of heights occurred between age 11 and 18 years among individuals who reported higher levels of non-specific stress at age 15. Interestingly, there was no evidence for dental fear dishabituation--a finding consistent with the non-associative model of fear acquisition. Strengths and weaknesses of the study were considered and the results discussed in relation to laboratory-based findings on (dis)habituation.

Adolescent↗
PubMed2000

Processing of phobic stimuli and its relationship to outcome.

In the present study, we explored factors related to successful treatment outcome in a sample of participants with fear of spiders. We specifically examined the relationship of general memory, memory for the phobic stimulus, memory for anxious responses, and perceived self-efficacy to treatment outcome. Forty-eight participants who were afraid of spiders participated in two sessions of in vivo exposure therapy. On day 1, participants completed measures of general memory, memory for the phobic stimulus, recall of anxiety level during exposure tasks, and self-efficacy during exposure tasks. At post-treatment, better memory for anxious responses, but not memory for the phobic stimulus, was related to lower anticipatory and actual anxiety. Greater self-efficacy, on the other hand, was related to better behavioral performance.

Adult↗
PubMed2000

Pain-sensitive temperament: does it predict procedural distress and response to psychological treatment among children with cancer?

OBJECTIVE: To evaluate the relationship between pain sensitivity and children's distress during lumbar punctures (LPs), and whether pain sensitivity functions as a moderator of children's responses to a psychological intervention aimed at reducing LP distress. METHOD: Fifty-five children with acute lymphoblastic leukemia (ages 3 to 18) and their parents completed a questionnaire measure of pain sensitivity. Self-report, physiological, and observed measures of distress were collected during the study baseline LP. Children were then randomized into a psychological intervention or an attention control group. Postintervention and follow-up LPs were observed. RESULTS: Higher levels of pain sensitivity were associated with greater anxiety and pain, both prior to and during the LP. Preliminary analyses indicated that pain sensitivity moderated the effects of intervention on distress. Children who were more pain-sensitive and who received no intervention showed greater increases in LP distress over time. In contrast, children who were more pain-sensitive and who received intervention showed greater decreases in LP distress over time. CONCLUSIONS: A measurement of pain sensitivity may be useful in pediatric oncology settings for effectively targeting pain-vulnerable children for psychological intervention. Preliminary analyses indicate that an empirically-supported intervention for procedural distress is efficacious for those children who are most pain-sensitive.

Adaptation, Psychological↗
PubMed1999

Nocturnal panic and trauma.

We examined the recollection of traumas in panic disorder patients with and without history of nocturnal panic attacks. From a sample of 154 patients seeking treatment for panic disorder, almost 85% of those with nocturnal panic reported a history of traumatic events in comparison to only 28% without nocturnal panic. Fear of loss of vigilance is considered as a potential mediator of the relationship between nocturnal panic and traumatic events.

Adult↗
PubMed1999

Worry affects the immune response to phobic fear.

Worry, the cognitive enumeration and anticipation of potential future negative events, is associated with autonomic dysregulation, which may in turn have implications for the immune system. People endorsing high (n = 7) and normal levels of trait worry (n = 8) were briefly exposed to a phobic stimulus and the autonomic and immune responses and recovery were assessed. A time-matched control group (n = 6) was not exposed to any stimulus. Both worry groups showed increased heart rate and skin conductance in response to phobic fear. However, only the normal worry group showed a concomitant increase in natural killer cells in peripheral blood. Patterns of change during the follow-up period suggested that phobic fear had disrupted a normal circadian increase in natural killer cells. Adrenergic and hypothalamus-pituitary-adrenal mechanisms may be responsible for the differences between high and normal worry groups in their natural killer cell response to and recovery from phobic fear.

Adult↗
PubMed1999

Water trauma and swimming experiences up to age 9 and fear of water at age 18: a longitudinal study.

A small number of retrospective studies on the etiology of specific fears have obtained findings consistent with a biological (non-associative) explanation of fear acquisition. Unfortunately, reliance on imperfect memory to recall conditioning events which occurred many years earlier limits the conclusions that can be drawn from such data. The present investigation attempts to overcome this methodological shortcoming by examining the relationship between water trauma (i.e. conditioning) and water skills (e.g. swimming) before the age of 9 and the presence of water fear and phobia at age 18 in a longitudinal birth cohort. We found no evidence of a relationship between water confidence and water trauma up to the age of 9 and fear of water at age 18. Similar findings were obtained for water phobia at age 18 with the exception that study members who were less able to immerse themselves in water with confidence at age 9 were more likely to report water phobia at age 18. Associative and non-associative explanations of these findings were discussed.

Adolescent↗
PubMed1999

Context-specificity of relapse: effects of therapist and environmental context on return of fear.

Context-specificity of fear extinction was tested among 65 participants who were fearful of spiders by manipulating the contexts used for exposure treatment and two-week follow-up assessment. Context was defined by both meaningful (presence of a particular therapist) and incidental (room location and furnishings) environmental cues. Distinct phobic stimuli were used to examine interactions of context with stimulus. Physiological, behavioral and verbal indices of fear were measured. Results provided modest support for context-specific return of fear. With one stimulus, participants assessed in a non-treatment context at follow-up exhibited greater returns in heart rate levels. In addition, three of four participants who could not touch the stimulus at follow-up had been tested in a non-treatment context. Future investigations may benefit from greater distinctions between contexts or manipulation of contextual features more directly relevant to fear. Finally, post hoc analyses identified high trait anxiety, slow treatment response, recovery of phobic cognitions and long duration/high intensity phobic encounters post-treatment as significant predictors of increased return of fear.

Adolescent↗