Biomedical subjects

R M Rapee

Publications and source records attributed to R M Rapee.

At least 37 records · Page 2Linked to original sources

PubMed1995

Cognitive-behavior therapy for generalized anxiety disorder.

Overall, cognitive-behavior therapy shows promise as a treatment for GAD. The modest treatment gains reported to date may be in part due to the characterologic nature of GAD and the high rate of comorbidity. An important trend emerging in studies that provide long-term outcome data, however, is the substantial reduction in the use of anxiolytic medication in treated subjects. As a result, Brown et al have suggested that such cognitive-behavior therapy may offer an approach for discontinuing these medications in patients with GAD. Because the benefits of cognitive-behavioral treatment appear to be maintained at long-term follow-up assessment, cognitive-behavior therapy may provide a long-term and cost-effective solution to GAD. The maintenance of treatment gains following a relatively short period of intervention (5-20 sessions) is particularly impressive given that the GAD population is characterized by individuals who say that they have "always been worriers" and who previously have been very difficult to treat. Future research is required to explore the specific effects that "nonspecific" methods offer. In addition, because some studies (e.g., Barlow et al) reported that dropouts in treatment were high and that many patients were left with some residual anxiety, there is clearly still a need for further research to find more focused and successful treatments.

Adaptation, Psychological↗

PubMed1994

The nature of feared outcome representations in children.

The present study investigated the way in which feared outcomes are organized in long-term memory in children and adolescents. A list of items relating to threatening outcomes, originally generated by children, was given to an additional 560 children (aged 6 to 16) and rated for the degree to which they worried about each. Factor analysis revealed two interpretable factors of feared outcomes. The first factor centered on concerns about physical harm while the second factor centered on social consequences that children and adolescents worry about. The two factors were consistent across gender, age, and clinical status. A scale involving the maximally discriminating items showed good internal consistency and test-retest reliability.

Adolescent↗

PubMed1994

Memory bias in social phobia.

To examine memory bias for social threat in social phobics, four studies are reported in which social phobic and nonclinical Ss are compared on their retrieval of threat-relevant information. Study 1 measured standard recall and recognition of threat, neutral, and positive words, while Study 2 assessed retrieval of these words through implicit and explicit tasks. The two final studies attempted to increase the validity of the procedures. Study 3 examined recall of feedback in a hypothetical public performance task and Study 4 examined autobiographical memory for social and neutral situations. All four studies consistently failed to find any evidence for biased retrieval processes in social phobics.

Adult↗

PubMed1994

Detection of somatic sensations in panic disorder.

Twenty-four panic disorder patients and 25 nonclinical subjects underwent double-breath inhalations of 5, 10, and 20% carbon dioxide (CO2) or room air. All subjects were blind to inhalation content and were required to guess if the inhalation contained CO2. There was no significant difference between groups in the accuracy with which they were able to detect CO2 at any concentration. Similarly, the number of somatic symptoms reported to each inhalation did not differ between groups. The findings question suggestions that individuals with panic disorder are more accurate at detecting changes in physiology than other individuals.

Adult↗

PubMed1994

Fear of physical sensations and trait anxiety as mediators of the response to hyperventilation in nonclinical subjects.

Three studies were conducted to compare the ability of a measure of fear of physical sensations (Anxiety Sensitivity Index; ASI) and a measure of trait anxiety (State-Trait Anxiety Inventory; STAI) to predict response to hyperventilation. In the first study subjects (N = 43) were selected who differed in scores on the ASI but were equated on levels of trait anxiety. Two other studies were conducted in which subjects (ns = 63 and 54) varied randomly on ASI and STAI scores. The results indicate that scores on the ASI account for a significant proportion of variance in the response to hyperventilation that is not accounted for by scores on the STAI.

Adult↗

PubMed1994

Reliability of the DSM-III-R childhood anxiety disorders using structured interview: interrater and parent-child agreement.

OBJECTIVE: The aim of the study was to examine the interrater and parent-child agreement for the major child anxiety disorders. METHOD: One hundred sixty-one children and their parents underwent a semistructured interview (Anxiety Disorders Interview Schedule for Children). To increase external validity, clinicians did not receive specific, extensive training in diagnosing anxiety disorders apart from their standard qualifications. The design of the study allowed for calculation of agreement between raters based on information obtained from the parents alone, from the child alone, or through combined information from both the parents and child, and for calculation of agreement between information obtained from the parents and information obtained from the child. RESULTS: Levels of interrater agreement either as principal or additional diagnoses were moderate to strong for all of the major childhood anxiety disorders (kappa values .59 to .82). In contrast, parent-child agreement was poor for most diagnostic categories (kappa values .11 to .44). CONCLUSIONS: The data indicate that, despite the fact that parents and their children do not demonstrate strong agreement, the DSM-III-R childhood anxiety disorders can be reliably diagnosed by pairs of general clinicians using structured interviews.

Adolescent↗

PubMed1993

Reliability of DSM-III-R anxiety disorder categories. Using the Anxiety Disorders Interview Schedule-Revised (ADIS-R).

A large reliability study of DSM-III-R anxiety disorders is reported in which outpatients (n = 267) received two independent structured interviews (Anxiety Disorders Interview Schedule-Revised). It is the only reliability study to date in which the final DSM-III-R criteria are used throughout the study. Reliability was assessed for each diagnosis when it was assigned as a principal diagnosis and when it was assigned as either a principal or an additional diagnosis. Excellent reliability was obtained for current principal diagnoses of simple phobia, social phobia, and obsessive-compulsive disorder. Agreement was good for panic disorder when all severity levels of agoraphobic avoidance were combined. Reliability was fair for generalized anxiety disorder. Remaining diagnostic difficulties, particularly in identifying levels of agoraphobic avoidance and in reliably diagnosing generalized anxiety disorder, are discussed in the context of changes in diagnostic criteria that are under consideration for DSM-IV.

Adult↗

PubMed1993

The representation of feared outcomes.

A list of negative outcomes (harmful events) was constructed to investigate the nature and organization of outcome concerns in anxiety. In Study 1, analysis of worry frequency ratings for the 116 negative outcomes revealed two major correlated factors corresponding to physical outcomes (harm or misfortune) and social outcomes (negative evaluation). These higher-order factors could be further subdivided into smaller discrete categories of related concerns. Ratings of worry frequency were higher for social outcomes. Trait anxiety was associated with both physical and social concerns, but stress and depression were primarily associated with social concerns. In Study 2, aversiveness ratings for the 116 negative outcomes followed the same physical-social organization and formed similar lower-order categories. Unlike the worry frequency ratings, aversiveness ratings were higher for physical than social categories, and did not correlate substantially with trait measures of depression, anxiety or stress. In Study 3, a short (24-item) negative outcome questionnaire was developed to discriminate between concerns about physical and social outcomes. The Physical Scale correlated substantially with the Anxiety Sensitivity Index (ASI) but not the Fear of Negative Evaluation (FNE), whereas the Social Scale correlated with the FNE but not the ASI. The Penn State Worry Questionnaire (PSWQ), which assesses worry frequency but not content, correlated only with the Social Scale. Implications for theories of normal and clinical anxiety are discussed.

Adult↗

PubMed1993

The utilisation of working memory by worry.

Sixty-eight undergraduate students were randomly allocated to one of four task conditions and required to worry about a topic of importance to them while simultaneously performing the task to which they had been allocated. The tasks differed in their ability to interfere with worrying. Generation of random letters was the only task to interfere significantly with the ability to worry. There was a nonsignificant tendency for articulatory suppression to produce some interference with worrying while visuo-spatial tasks did not affect the ability to worry. There was no difference in results between self-reported worriers and non-worriers. The results seem to indicate that worry primarily utilises the phonological aspect of the central executive of working memory.

Adult↗

PubMed1992

Differences in reported symptom profile between panic disorder and other DSM-III-R anxiety disorders.

Previous research has indicated that reports of panic attacks are associated with a different set of symptoms to reports of generalized anxiety. The present two studies attempted to extend these findings to specific (situational) fears. In Study 1, 55 subjects with panic disorder were compared on their symptom profile during their panic attacks to 65 subjects with other anxiety disorders [simple phobia, social phobia and obsessive-compulsive disorder (OCD)] during response to their feared cue. The results indicated that, compared to subjects with other anxiety disorders, subjects with panic disorder were more likely to report parasthesias, dizziness, faintness, unreality, dyspnea, fear of dying and fear of going crazy/losing control. In Study 2, 90 subjects meeting diagnostic criteria for both panic disorder and another anxiety disorder (simple phobia, social phobia or OCD) were compared on the symptoms experienced during their unexpected panic attacks and their situationally-triggered fears respectively. Combining the symptoms found in Study 1 to differ between the groups into a linear combination, there was a significant interaction found between the type of fear reaction (panic attack vs cued fear response) and symptom group. Taken together, these findings suggest that reports of unexpected panic attacks associated with panic disorder are characterized by a different symptom profile to reports of specific fear reactions that are part of a phobic disorder or OCD.

Adult↗

PubMed1992

Response to hyperventilation and inhalation of 5.5% carbon dioxide-enriched air across the DSM-III-R anxiety disorders.

Anxiety disorder patients (n = 198; under criteria of the Diagnostic and Statistical Manual of Mental Disorders; rev. 3rd ed.; American Psychiatric Association, 1987) and nonanxious control subjects (n = 25) underwent challenges of 90 s of voluntary hyperventilation and 15 min of 5.5% carbon dioxide in air. Panic disorder subjects showed a greater subjective response to both challenges than did subjects with other anxiety disorders, who in turn responded more than did control subjects. Furthermore, subjects with panic disorder as an additional diagnosis tended to report more subjective response than did anxiety disorder subjects without panic disorder. The best prechallenge predictor of response to each procedure was a measure of fear of physical symptoms. The findings support previous results that have pointed to a greater fear or anxiety-inducing effect of these challenge procedures in panic disorder patients, as compared with other subjects.

Adult↗

PubMed1992

Discrepancy between self- and observer ratings of performance in social phobics.

Twenty-eight subjects meeting Diagnostic and Statistical Manual of Mental Disorders (rev. 3rd ed.; American Psychiatric Association, 1987) criteria for social phobia and without a comorbid affective disorder and 33 nonclinical controls were asked to present a brief, impromptu speech to a small audience. Speakers themselves, as well as members of the audience, rated each speaker on a public speaking questionnaire that included both specific items (e.g., voice shook) and global items (e.g., appeared confident). For global items, no significant difference was indicated between the two groups on observers' ratings of public speaking performance. However, social phobics rated their own performance worse than did nonclinical controls, and there was a significantly greater discrepancy between self and other ratings for social phobics than controls. Fear of negative evaluation was the only significant predictor of the self-other discrepancy on global items.

Adult↗

PubMed1991

The role of safety cues in mediating the response to inhalations of CO2 in agoraphobics.

Eighteen subjects meeting DSM-III-R criteria for panic disorder with agoraphobia were randomly allocated to either a safety or non-safety condition and underwent 15 min inhalations of 5.5% CO2 in air. In the safety condition, both a senior and junior experimenter were present, the junior experimenter was presented as a professional, and subjects were in personal contact with the senior experimenter throughout the procedure. In the non-safety condition, the senior experimenter left on a bogus emergency, the junior experimenter was introduced as a "student" and was dressed casually, and subjects were alone in the experimental room throughout the procedure. Despite these dramatic manipulations, there was no significant difference between groups on either the number of subjects experiencing a panic attack or on pre-inhalation safety scores. However, a median-split analysis on safety scores indicated that those subjects who perceived themselves to be less safe before the inhalation were more likely to experience a panic attack.

Adult↗

PubMed1990

Interaction of neuropsychological and psychological factors in two cases of "space phobia".

Recent theories of psychological disorders are beginning to break down the traditional dichotomy between mental and physical processes. The present paper reports on two cases of space phobia in which this is especially apparent. Neuropsychological assessment indicated subtle disturbance in visuospatial functioning. The emotional response to this dysfunction appeared, however, to be somewhat excessive given the subtlety of the deficit. This is seen as a psychological reaction to a neuropsychological dysfunction.

Accidental Falls↗

PubMed1990

Syndrome comorbidity in patients diagnosed with a DSM-III-R anxiety disorder.

One hundred thirty patients presenting at an anxiety disorders research clinic were administered a structured interview (i.e., Anxiety Disorders Interview Schedule-Revised). Diagnoses were made in accordance with Diagnostic and Statistical Manual (rev. 3rd ed.) criteria. Seventy percent of patients received at least one additional but secondary Axis I diagnosis. The most common additional diagnoses were simple and social phobia, which were assigned to nearly one third of all patients. In addition, 33% of anxiety disorder patients received an additional diagnosis of a depressive mood disorder (i.e., dysthymia or major depression). The distribution of specific additional diagnoses are presented for each principal anxiety disorder category. The scientific and clinical implications of comorbidity are discussed while considering the relatively high patterns of syndrome comorbidity found in the present study, which is consistent with several earlier studies.

Adult↗

PubMed1990

Impact of life events on subjects with panic disorder and on comparison subjects.

A questionnaire measure of major life events was given to 64 subjects with diagnoses of panic disorder with agoraphobia, 33 subjects with other anxiety disorders, and 34 nonanxious subjects. Anxious subjects indicated the life events that had occurred in the 6-month period immediately before their current disorder began and rated the impact of each event on a 7-point scale. Nonanxious subjects made the same ratings for a 6-month period 1 1/2-2 years before the study. There was no significant difference between groups in the number of life events reported. However, anxious subjects rated these events as having a significantly greater negative impact than did nonanxious subjects.

Adult↗

PubMed1989

The influence of an illusion of control on panic attacks induced via inhalation of 5.5% carbon dioxide-enriched air.

The current study tested the notion that a sense of control can mitigate anxiety and panic attacks caused by the inhalation of 5.5% carbon dioxide (CO2)-enriched air. Twenty patients with panic disorder inhaled a mixture of 5.5% CO2-enriched air for 15 minutes. All patients were instructed that illumination of a light directly in front of them would signal that they could decrease the amount of CO2 that they were receiving, if desired, by turning a dial attached to their chair. For ten patients, the light was illuminated during the entire administration of CO2. For the remaining ten patients, the light was never illuminated. In fact, all patients experienced the full CO2 mixture, and the dial was ineffective. When compared with patients who believed they had control, patients who believed they could not control the CO2 administration (1) reported a greater number of DSM-III-revised panic attack symptoms, (2) rated the symptoms as more intense, (3) reported greater subjective anxiety, (4) reported a greater number of catastrophic cognitions, (5) reported a greater resemblance of the overall inhalation experience to a naturally occurring panic attack, and (6) were significantly more likely to report panic attacks. These data illustrate the contribution of psychologic factors to laboratory induction of panic attacks through inhalation of 5.5% CO2-enriched air.

Administration, Inhalation↗

PubMed1989

Qualitative dimensions of worry in DSM-III-R generalized anxiety disorder subjects and nonanxious controls.

Revisions to DSM-III cite apprehensive expectation or 'worry' as a defining feature of generalized anxiety disorder (GAD). The quality and focus of worry reported by groups of GAD patients (n = 19), and nonanxious 'controls' (n = 26) were examined using self-monitored data. Content categorizations by independent raters showed that GAD patients worried more about illness, health and injury issues and displayed a tendency to worry more about miscellaneous 'minor' issues. These descriptor ratings differentiated the worries of GAD patients from those of non-anxious controls: perceived control over worrying, the extent to which the worry was considered realistic, and perceived success with which worry was alleviated using corrective/preventative actions. The data are related to the DSM-III-R criteria for GAD and to conceptualizations of the nature of excessive worry.

Adult↗