Biomedical subjects

M J Telch

Publications and source records attributed to M J Telch.

At least 19 recordsLinked to original sources

PubMed1999

Dissociation in the laboratory: a comparison of strategies.

Several methods for inducing dissociation in the laboratory were examined in a sample of 78 undergraduate students. Participants scoring high or low on the Dissociative Experiences Scale participated in three dissociation challenge conditions: (a) dot-staring task, (b) administration of pulsed photic and audio stimulation and (c) stimulus deprivation. Participants recorded their dissociative experiences both before and after each of the three challenge conditions. Across conditions, high DES participants reported significantly more dissociative sensations than low DES participants, even after controlling for pre-challenge dissociation. Moreover, regardless of DES status, pulsed photo and audio stimulation produced the greatest level of dissociative symptoms. The findings suggest that the induction of dissociative symptoms in a nonclinical sample is easily accomplished in the laboratory and that those who report more dissociative symptoms in their day-to-day life exhibit more pronounced dissociative symptoms when undergoing dissociative challenge in the laboratory. Implications for the study and treatment of dissociative symptoms are discussed.

Acoustic Stimulation↗

PubMed1997

Nonpsychiatric medical comorbidity, health perceptions, and treatment outcome in patients with panic disorder.

Panic disorder is frequently complicated by high rates of co-occurring nonpsychiatric medical conditions. The present study examined the relationship between medical morbidity, perceived physical health, and treatment outcome in panic disorder. Patients meeting the American Psychiatric Association's Diagnostic and Statistical Manual of mental disorders (1994) criteria for panic disorder (N = 71) completed 12 sessions of cognitive-behavioral treatment and were assessed at posttreatment and 6-month follow-up. Medical comorbidity and perceived health were both found to be related to end-state functioning. Medical comorbidity did not uniquely predict outcome beyond its shared variance with perceived health. At posttreatment, 71% of patients who perceived their physical health as good met recovery criteria compared with only 35% of those who perceived their health as poor. At follow-up, 67% of those who perceived their physical health as good met composite recovery criteria compared with only 33% of those with perceived poor health. These findings offer preliminary support for the impact of physical health, both actual and perceived, on treatment outcome of patients with panic disorder.

Adult↗

PubMed1996

Biological challenge manipulation of PCO2 levels: a test of Klein's (1993) suffocation alarm theory of panic.

D.F. Klein (1993) proposed that patients with panic disorder (PD) have a hypersensitive suffocation monitor that predisposes them to experience panic attacks under certain conditions. The suffocation alarm theory predicts differential emotional responding to biological challenges that affect arterial partial pressure of carbon dioxide (PCO2). These PD patients should exhibit (a) lower fear and less likelihood of panic in response to biological challenges that lower PCO2 levels (e.g., hyperventilation), and (b) increased fear and greater likelihood of panic in response to biological challenges that raise PCO2 levels (e.g., inhalation of 35% CO2 gas). The following indicators of the suffocation monitor were assessed: (a) severity of dyspnea symptoms, (b) frequency of dyspnea symptoms, (c) heightened respiration rate, and (d) lowered PCO2 levels. Ratings of physiological and subjective responding, as well as panic, were obtained during both a hyperventilation and a 35% CO2 challenge. None of the classification methods predicted differential emotional responding to hyperventilation versus 35% CO2 challenge.

Adult↗

PubMed1996

Prospective evaluation of panic potentiation following 35% CO2 challenge in nonclinical subjects.

OBJECTIVE: The authors examined the effect of panic provocation on the subsequent development of panic attacks and panic disorder in nonclinical subjects with no history of spontaneous panic. METHOD: Sixty-two subjects who had completed a study examining fearful responses to a single vital capacity inhalation of 35% CO2 were reevaluated 1 year following the challenge test. RESULTS: Challenge-induced panic was not related to the later development of panic or panic disorder. According to the Structured Clinical Interview for DSM-III-R--Non-Patient Edition, none of the subjects met DSM-III-R criteria for panic disorder and only six subjects reported spontaneous panic during the year after panic provocation. Of the six subjects who experienced spontaneous panic, two had panicked in response to the CO2 challenge. CONCLUSIONS: The experimental provocation of panic in nonclinical subjects appears to be a safe research paradigm for exploring the psychopathogenicity of panic disorder.

Administration, Inhalation↗

PubMed1995

Impact of cognitive-behavioral treatment on quality of life in panic disorder patients.

Panic disorder (PD) is associated with significant social and health consequences. The present study examined the impact of treatment on PD patients' quality of life. Patients (N = 156) meeting DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders [3rd ed., rev.]; American Psychiatric Association, 1987) criteria for PD with agoraphobia were randomly assigned to group cognitive-behavioral treatment (CBT) or a delayed-treatment control. An assessment battery measuring the major clinical features of PD as well as quality of life was administered at baseline (Week 0), post-treatment (Week 9) and 6-month follow-up (Week 35). Consistent with previous studies, PD patients displayed significant impairment in quality of life at intake. Compared with delayed-treatment control participants, CBT-treated participants showed significant reductions in impairment that were maintained at follow-up. Consistent with prediction, anxiety and phobic avoidance were significantly associated with quality of life, whereas frequency of panic attacks was not.

Adult↗

PubMed1994

Match-mismatch of fear, panic and performance.

The present study tested predictions derived from Rachman's match-mismatch theory of fear. Students (N = 117) displaying claustrophobic fear made predictions of fear, panic and performance prior to exposure to a claustrophobic chamber. Subjects were then classified into groups (i.e. matchers, overpredictors, underpredictors) based on the congruence between their anticipated phobic reactions and their actual reactions during exposure. The effects of match-mismatch status on predictions of fear, panic and performance on a subsequent exposure trial were examined. Results provided further evidence that phobic Ss are frequently inaccurate in predicting their phobic reactions during exposure. Consistent with previous findings, Ss who overpredicted fear, panic or performance tended to lower their predictions on a subsequent exposure trial, whereas Ss who underpredicted fear, panic or performance showed heightened predictions upon subsequent exposure. Contrary to previous findings, Ss were more likely to underpredict rather than overpredict their phobic reactions. Our findings are in accord with those of Rachman indicating that the magnitude of mismatch between predicted and actual fear/panic is more influential in determining subsequent predictions of fear/panic than it is in determining Ss' actual fear/panic. Moreover, this asymmetry was observed when the mismatch paradigm was applied to phobic behavior (i.e. tendency to escape).

Adolescent↗

PubMed1994

The overprediction of fear and panic in panic disorder.

The present study examined changes in the prediction of fear and panic in a clinical sample of patients (N = 25) meeting DSM-III-R criteria for panic disorder with agoraphobia (PDA). Data were collected for approx. 2000 trials of in vivo exposure. As expected, PDA patients displayed a bias for overpredicting both the level of fear and the likelihood of panic during an exposure trial. This overprediction bias was evidenced across several domains including heights, transportation and social situations. Although patients learned to make more accurate predictions within an exposure session, the level of overprediction remained relatively stable after the third trial within a session. Changes in fear overprediction differed across fear domains. Patients showed significant reductions in overprediction during exposure to transportation and social situations, but failed to show reductions in overprediction during exposure to heights. Unexpectedly, patients did not show increased prediction accuracy across sessions. These findings concur with earlier laboratory studies indicating that anxiety patients show an overprediction bias for panic and fear which decreases with practice. However, our findings indicate that the overprediction bias does not remit even after significant practice. The persistence of the overprediction bias is discussed within an evolutionary context.

Adolescent↗

PubMed1994

Proximity to safety and its effects on fear prediction bias.

We tested the hypothesis that the perceived availability of safety resources plays an influential role in fear prediction bias. Claustrophobic Ss (N = 37) completed a claustrophobic challenge under conditions of either low or high proximity to safety. Proximity to safety was operationalized as distance from the exit. We examined the effects of proximity to safety on Ss' predicted fear, actual fear, and discrepancy between predicted and actual fear (prediction bias). Consistent with prediction, the availability of safety resources had a more pronounced effect on Ss' actual fear than Ss' predicted fear. Moreover, subjects displayed a significant underprediction bias when proximity to safety was low and a slight (albeit nonsignificantly) overprediction bias when proximity to safety was high. Our results lend further support for the hypothesis that anxious Ss underutilize safety information when confronting perceived threats. Possible mechanisms underlying this tendency are discussed.

Adolescent↗

PubMed1993

Group cognitive-behavioral treatment of panic disorder.

The present study examined the efficacy of an 8-wk, cognitive-behavioral group treatment for panic disorder. Patients meeting DSM-III-R criteria for panic disorder with or without agoraphobia were randomly assigned to treatment (N = 34) or delayed treatment control (N = 33). The treatment consisted of: (a) education and corrective information; (b) cognitive therapy; (c) training in diaphragmatic breathing; and (d) interoceptive exposure. At posttreatment, 85% of treated Ss were panic free, compared to 30% of controls. Treated Ss also showed clinically significant improvement on indices of anxiety, agoraphobia, depression and fear of fear. Recovery, as estimated conservatively by the attainment of normal levels of functioning on each of the major clinical dimensions of the disorder (i.e. panic, anxiety and avoidance), was achieved in 64% of the treated Ss and 9% of the controls. At the 6 month follow-up, 63% of the treated patients met criteria for recovery. These findings mirror those from recently-completed trials of individually-administered cognitive-behavioral treatment, and suggest that CBT is a viable alternative to pharmacotherapy in the treatment of panic disorder.

Adult↗

PubMed1993

Psychological treatment of panic: work in progress on outcome, active ingredients, and follow-up.

Initial interest in the causes and treatment of panic disorder was triggered by biological theories and investigators. More recently, however, research on newly developed psychological approaches for panic has advanced our understanding of the disorder and has led to the development of specific treatment programs. Typically, these programs consist of a range of treatment components that more or less directly target panic attacks and the fears and behaviors associated with them. The paper reviews four studies evaluating these programs that have recently been completed or are close to completion in different centers in the United States (Albany, New York; Austin, Texas) and Europe (Oxford, England; Marburg, Germany). Conforming to strict methodological standards, these studies report consistently high success rates and temporal stability of the treatment gains. About 80% or more of the patients receiving combined cognitive-behavioral treatments achieved panic free status as well as strong and clinically significant improvement in general anxiety, panic-related cognitions, depression, and phobic avoidance. Furthermore, these gains were maintained at follow-ups of up to 2 years. The success of these psychological treatments compares favorably with the outcome for the established pharmacological treatments. In addition, the studies provide new insights into the active ingredients that may operate in cognitive-behavioral treatments for panic disorder and show the feasibility of group treatments. Together, these studies underscore the fact that cognitive-behavioral treatments rest on firm experimental evidence that justifies their application in everyday practice as well as continued research into their mechanisms of action.

Arousal↗

PubMed1993

Claustrophobic fear behavior: a test of the expectancy model of fear.

The present study examined Reiss and McNally's expectancy model in the prediction of claustrophobic fear, measured across three domains. Non-clinical subjects (N = 117) reporting claustrophobic concerns were administered a behavioral approach test to a claustrophobic chamber. Consistent with the expectancy model, danger expectancy, anxiety expectancy and the interaction of anxiety sensitivity and anxiety expectancy accounted for unique portions of behavioral performance, with other variables partialled out. The expectancy model variable set, however, did not meaningfully relate to subjective fear or heart-rate reactivity. The formulation of anxiety sensitivity as a measure of the salience of anxiety is discussed. These findings lend support to the theory as a model for the behavioral dimension of pathological fear, but not the subjective or physiological facets.

Adolescent↗

PubMed1990

Social influences approach to smoking prevention: the effects of videotape delivery with and without same-age peer leader participation.

This study tested the hypothesis that cigarette smoking adoption among adolescents could be suppressed by providing school-based videotape instruction for resisting social influences to smoke. The utilization of same-age peer leaders was also varied to test whether their participation in the classroom would enhance program effects. Seventh grade students (N = 540) from one junior high school in Southern California were randomly assigned by classrooms (N = 15) to: (a) videotape instruction, (b) videotape instruction plus peer leader involvement, or (c) survey-only. Seventh grade students (N = 234) in a second junior high school served as a measurement-only control. Assessments were conducted at the beginning and end of the academic year. Results revealed a marked suppression in the onset of both experimental and regular smoking among those students exposed to the pressure resistance training with peer leader involvement. Pressure resistance training without peer leader involvement produced a more variable and less powerful effect on students' smoking behavior. Data collected on students' use of alcohol and marijuana revealed a generalized suppression effect, albeit weaker than for tobacco, among those students exposed to the social resistance training with peer leader involvement. Results provide further encouraging support for the use of peer-led pressure resistance training in preventing adolescent drug use.

Adolescent↗

PubMed1989

Role of cognitive appraisal in panic-related avoidance.

The present study examined several dimensions of panic cognitions to test whether panic appraisals predict phobicity among panic sufferers. Thirty-five patients meeting DSM-III-R criteria for panic disorder with minimal or no phobic avoidance were compared to 40 patients meeting DSM-III-R criteria for panic disorder with agoraphobia (severe). The two groups looked strikingly similar on measures of panic symptoms, panic frequency and panic severity. As expected, patients diagnosed as having panic disorder with agoraphobia reported significantly more depression and phobic avoidance than patients with PD. Striking differences emerged on each of the following panic appraisal dimensions: (a) anticipated panic, (b) perceived consequences of panic, and (c) perceived self-efficacy in coping with panic. In each case, patients with panic disorder and agoraphobia reported significantly more dysfunctional panic appraisals than patients with panic disorder and no avoidance. Of those panic appraisal dimensions studied, anticipated panic emerged as the most potent correlate of agoraphobic avoidance. These findings support the hypothesis that cognitive appraisal factors may play an important role in the genesis or maintenance of phobic avoidance among panic patients.

Adult↗

PubMed1989

Acquisition of smoking refusal skills in junior high school students.

This study examined the effects of a smoking prevention program on the acquisition of refusal skills among junior high school students. Two conditions were compared: one in which the subjects participated in a videotaped training program on resisting pressures to smoke, and the other an untreated control group. As predicted, the results showed significant improvement in the skill training group, while the untreated controls showed no change relative to their pretest performance. These findings suggest that smoking prevention programs which focus on resisting social pressures can enhance the young person's ability to say "no" to smoking.

Adolescent↗

PubMed1989

Nonclinical panic in college students: an investigation of prevalence and symptomatology.

This article presents data on the prevalence and symptomatology of panic attacks and panic disorder (PD) in a large nonclinical sample (n = 2,375) of college students. Results showed that approximately 12% of the sample had experienced at least one unexpected panic attack and that 2.36% met DSM-III-R criteria for panic disorder. Although there were no sex differences in overall panic attack prevalence, men reported significantly more panic-related worry than women, and women reported a higher panic frequency than men. Compared to subjects who met DSM-III-R criteria for PD, infrequent panickers presented with fewer panic symptoms, fewer panic episodes, less panic-related worry, lower anxiety sensitivity, and less panic-related avoidance. Moreover, compared with PD subjects, the infrequent panickers were much less likely to report fears of dying, going insane, and derealization during a panic attack. The findings provide preliminary support for the role of anxious apprehension as a psychological vulnerability factor in the pathogenesis of panic disorder.

Adolescent↗

PubMed1989

The Stanford Adolescent Heart Health Program.

This study was designed to create, implement, and test a school-based multiple risk factor reduction program for high school students. All tenth graders in four senior high schools (N = 1447) from two school districts participated in the study. Within each district, one school was assigned at random to receive a special 20-session CVD risk reduction intervention and one school served as a control. The schools were matched for size and distribution of racial groups before randomization. At a two-month follow-up, knowledge gains were significantly greater for students in the treatment group on each of the risk factor domains tested: nutrition/diet (p less than 0.0001), physical activity (p less than 0.0001), and cigarette smoking (p less than 0.0001). Compared to controls, a higher proportion of those in the treatment group who were not exercising regularly at baseline, reported regular exercise at follow-up (p less than 0.0003). Almost twice as many baseline experimental smokers in the treatment group reported quitting at follow-up while only 5.6% of baseline experimental smokers in the treatment group graduated to regular smoking compared to 10.3% in the control group (p = 0.009). Students in the treatment group were more likely to report that they would choose heart healthy snack items (p less than 0.0001). Beneficial treatment effects were observed for resting heart rate (p less than 0.0001), BMI (p = 0.05), triceps skinfold thickness (p = 0.003), and subscapular skinfold thickness (p = 0.01). The results suggest that it is feasible to provide CVD risk reduction training to a large segment of the population through school-based primary prevention approaches.

Adolescent↗

PubMed1988

Minimal contact treatment for smoking cessation. A placebo controlled trial of nicotine polacrilex and self-directed relapse prevention: initial results of the Stanford Stop Smoking Project.

To determine the effectiveness of nicotine polacrilex combined with self-administered relapse prevention materials in maintaining smoking cessation, we conducted a randomized, double-blind, placebo controlled trial. Volunteers aged 18 to 65 years responding to media announcements were required to quit smoking for 48 hours without assistance. Of 1844 potential participants, 136 were medically excluded, 535 declined to make a quit attempt, and 573 were unable to quit, leaving 600 participants (35%) who were randomized. Eight self-help relapse prevention modules were mailed weekly. Gum was used either ad lib for smoking urges or on a fixed, hourly schedule (12 pieces per day). Only 15% of the subjects in each gum group stopped using the gum altogether because of side effects, but only 20% of the ad lib groups and 40% of the fixed-dosage group used at least eight pieces of gum per day during the first week. The abstinence rates (for at least seven days) at the six-month follow-up were 31% in both active gum groups and 22% in the placebo and no gum groups. Relapse rates in the two active gum groups were about half those in the placebo and no gum groups. Nicotine polacrilex may be a useful adjunct to minimal contact smoking cessation formats, which have broad appeal. Also, minimal contact relapse prevention programs may assist physicians in helping patients to maintain smoking cessation using nicotine polacrilex.

Adolescent↗

PubMed1988

Are heavy smokers different from light smokers? A comparison after 48 hours without cigarettes.

Correlates of heavy smoking (greater than or equal to 25 cigarettes per day) were examined in a group of 380 smokers participating in a minimal-contact smoking relapse prevention trial. The results indicate that heavy smokers are more dependent on cigarettes. Compared with smokers consuming 15 or fewer cigarettes per day, heavy smokers reported greater difficulty quitting, were more troubled by withdrawal symptoms, experienced stronger urges and cravings, and had higher scores on a modified version of the Fagerstrom tolerance questionnaire. Heavy smokers weighed more and were more obese as measured by body mass index. Eighty percent of heavy smokers were classified correctly using discriminant function analysis with two dependence-related measures entering as the most important discriminator variables. Logistic regression analyses yielded similar results. The findings underscore the importance of addressing potential physical dependence factors when developing smoking-cessation treatments for heavy smokers.

Adult↗