The cortisol awakening response predicts major depression: predictive stability over a 4-year follow-up and effect of depression history.

BACKGROUND: The cortisol awakening response (CAR) has been shown to predict major depressive episodes (MDEs) over a 1-year period. It is unknown whether this effect: (a) is stable over longer periods of time; (b) is independent of prospective stressful life events; and (c) differentially predicts first onsets or recurrences of MDEs. METHOD: A total of 270 older adolescents (mean age 17.06 years at cortisol measurement) from the larger prospective Northwestern-UCLA Youth Emotion Project completed baseline diagnostic and life stress interviews, questionnaires, and a 3-day cortisol sampling protocol measuring the CAR and diurnal rhythm, as well as up to four annual follow-up interviews of diagnoses and life stress. RESULTS: Non-proportional person-month survival analyses revealed that higher levels of the baseline CAR significantly predict MDEs for 2.5 years following cortisol measurement. However, the strength of prediction of depressive episodes significantly decays over time, with the CAR no longer significantly predicting MDEs after 2.5 years. Elevations in the CAR did not significantly increase vulnerability to prospective major stressful life events. They did, however, predict MDE recurrences more strongly than first onsets. CONCLUSIONS: These results suggest that a high CAR represents a time-limited risk factor for onsets of MDEs, which increases risk for depression independently of future major stressful life events. Possible explanations for the stronger effect of the CAR for predicting MDE recurrences than first onsets are discussed.

Neuroticism as a common dimension in the internalizing disorders.

BACKGROUND: Several theories have posited a common internalizing factor to help account for the relationship between mood and anxiety disorders. These disorders are often co-morbid and strongly covary. Other theories and data suggest that personality traits may account, at least in part, for co-morbidity between depression and anxiety. The present study examined the relationship between neuroticism and an internalizing dimension common to mood and anxiety disorders. METHOD: A sample of ethnically diverse adolescents (n=621) completed self-report and peer-report measures of neuroticism. Participants also completed the Structured Clinical Interview for DSM-IV (SCID). RESULTS: Structural equation modeling showed that a single internalizing factor was common to lifetime diagnosis of mood and anxiety disorders, and this internalizing factor was strongly correlated with neuroticism. Neuroticism had a stronger correlation with an internalizing factor (r=0.98) than with a substance use factor (r=0.29). Therefore, neuroticism showed both convergent and discriminant validity. CONCLUSIONS: These results provide further evidence that neuroticism is a necessary factor in structural theories of mood and anxiety disorders. In this study, the correlation between internalizing psychopathology and neuroticism approached 1.0, suggesting that neuroticism may be the core of internalizing psychopathology. Future studies are needed to examine this possibility in other populations, and to replicate our findings.

Fears, phobias, and preparedness: toward an evolved module of fear and fear learning.

An evolved module for fear elicitation and fear learning with 4 characteristics is proposed. (a) The fear module is preferentially activated in aversive contexts by stimuli that are fear relevant in an evolutionary perspective. (b) Its activation to such stimuli is automatic. (c) It is relatively impenetrable to cognitive control. (d) It originates in a dedicated neural circuitry, centered on the amygdala. Evidence supporting these propositions is reviewed from conditioning studies, both in humans and in monkeys; illusory correlation studies; studies using unreportable stimuli; and studies from animal neuroscience. The fear module is assumed to mediate an emotional level of fear learning that is relatively independent and dissociable from cognitive learning of stimulus relationships.

A modern learning theory perspective on the etiology of panic disorder.

Several theories of the development of panic disorder (PD) with or without agoraphobia have emerged in the last 2 decades. Early theories that proposed a role for classical conditioning were criticized on several grounds. However, each criticism can be met and rejected when one considers current perspectives on conditioning and associative learning. The authors propose that PD develops because exposure to panic attacks causes the conditioning of anxiety (and sometimes panic) to exteroceptive and interoceptive cues. This process is reflected in a variety of cognitive and behavioral phenomena but fundamentally involves emotional learning that is best accounted for by conditioning principles. Anxiety, an anticipatory emotional state that functions to prepare the individual for the next panic, is different from panic, an emotional state designed to deal with a traumatic event that is already in progress. However, the presence of conditioned anxiety potentiates the next panic, which begins the individual's spiral into PD. Several biological and psychological factors create vulnerabilities by influencing the individual's susceptibility to conditioning. The relationship between the present view and other views, particularly those that emphasize the role of catastrophic misinterpretation of somatic sensations, is discussed.

The effects of changing contexts on return of fear following exposure therapy for spider fear.

Treatment of specific fears and phobias is sometimes followed by a return of fear. Work with rats has provided evidence that a greater return of fear occurs when a conditioned stimulus extinguished in 1 context is later presented in a different context than if presented in the same context in which it was originally extinguished. In the present study, 36 human participants who were highly afraid of spiders received 1 session of exposure therapy (with participant modeling) and were then tested for return of fear 1 week later in either the same or a different context. It was hypothesized that there would be a greater return of fear in those participants treated and followed up in different contexts than in those treated and followed up in the same context. Participants tested in a novel context at follow-up showed a greater return of fear than participants tested in the same context. Limitations and areas for future study are discussed.

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.

Sex differences in perceived controllability of mate value: an evolutionary perspective.

Men and women value different characteristics in potential partners. It was hypothesized that women feel they have less control over traits relevant to their desirability than men feel they have over traits related to male desirability. In Study 1, undergraduates (N = 150) completed questionnaires measuring (a) the importance they attributed to 64 characteristics when choosing a mate and (b) their perceived control over these traits. Men selected partners on the basis of traits that are relatively uncontrollable (e.g., youth, attractiveness), whereas women selected partners on the basis of traits that are more controllable (e.g., status, industriousness; d = 1.75). In Study 2, these findings were replicated in an older, representative community sample (N = 301; d = 1.03). Greater uncontrollability of traits relevant to female mate value may place women at elevated risk for negative affect, depression, low self-esteem, and body dissatisfaction.

Attributional style and self-esteem: the prediction of emotional distress following a midterm exam.

A midterm design was used to determine whether students' attributional style for negative achievement events interacts with self-esteem and a lower-than-expected exam grade to predict changes in measures of specific and nonspecific depression and anxiety. Participants were 141 students who completed baseline measures of attributional style and self-esteem, as well as affective measures on several occasions before and after receipt of midterm grades. A pessimistic attributional style for negative events interacted with self-esteem and outcome to predict residual changes in a combined measure of nonspecific distress and anxious arousal (marginal trend) but not a combined measure of specific depressive symptoms. Unexpectedly, the greatest residual increases in distress occurred among low-self-esteem pessimists who experienced a nonfailure outcome. These effects did not appear to be mediated by changes in hopelessness.

Comorbidity of anxiety and unipolar mood disorders.

Research on relationships between anxiety and depression has proceeded at a rapid pace since the 1980s. The similarities and differences between these two conditions, as well as many of the important features of the comorbidity of these disorders, are well understood. The genotypic structure of anxiety and depression is also fairly well documented. Generalized anxiety and major depression share a common genetic diathesis, but the anxiety disorders themselves are genetically hetergeneous. Sophisticated phenotypic models have also emerged, with data converging on an integrative hierarchical model of mood and anxiety disorders in which each individual syndrome contains both a common and a unique component. Finally, considerable progress has been made in understanding cognitive aspects of these disorders. This work has focused on both the cognitive content of anxiety and depression and on the effects that anxiety and depression have on information processing for mood-congruent material.

Psychological preparedness for trauma as a protective factor in survivors of torture.

BACKGROUND: Although much research has focused on mechanisms of traumatization and factors related to post-trauma psychological functioning in survivors of trauma, there have been few studies of survivors of torture despite the widespread practice of torture in the world. The aim of this study was to examine the role of 'psychological preparedness' for trauma in post-traumatic stress responses in survivors of torture. METHOD: Thirty-four torture survivors who had no history of political activity, commitment to a political cause or group, or expectations of arrest and torture were compared with 55 tortured political activists, using structured interviews and measures of anxiety, depression, and post-traumatic stress disorder. RESULTS: Compared with tortured political activists, tortured non-activists were subject to relatively less severe torture but showed higher levels of psychopathology. Less psychological preparedness related to greater perceived distress during torture and more severe psychological problems, explaining 4% of the variance in general psychopathology and 9% of the variance in post-traumatic stress disorder symptoms. CONCLUSIONS: The study findings lend support to the role of prior immunization to traumatic stress and to unpredictability and uncontrollability of stressors in the effects of traumatization. Further research aimed at identifying the behavioural and cognitive components of psychological preparedness that play a role in traumatization may provide useful insights into effective treatment strategies for survivors of torture.

Pessimistic attributional style: is it specific to depression versus anxiety versus negative affect?

Two studies with college students explored the relationship of a pessimistic attributional style to positive and negative affect, as well as to depressed and anxious mood. Both studies revealed that a pessimistic attributional style was correlated with negative affect and depressed mood, but was unrelated to low levels of positive affect. The second study also showed a correlation with anxiety and that the association of pessimistic attributional style with emotional distress occurs for both depression-relevant (i.e. loss/failure) as well as anxiety-relevant (i.e. threatening) events. The second study also provided a longitudinal test of the diathesis-stress component of the reformulated helplessness theory. Results supported the hypothesis that pessimistic attributional style is a nonspecific diathesis for symptoms of both anxiety and depression. Implications for these findings for cognitive theories of depression are addressed.

Covariation bias for blood-injury stimuli and aversive outcomes.

Three illusory correlation experiments were conducted to determine whether a fear-relevant covariation bias (Tomarken, Mineka & Cook, 1989, Journal of Abnormal Psychology, 98, 381-394) could be demonstrated using different types of fear-relevant stimuli from the blood-injury phobia category. In each experiment, women high and low on blood-injury fear were presented with fear-relevant slides depicting blood or injury, as well as slides from two neutral categories. A shock (aversive outcome), or a tone or no outcome (neutral outcomes) followed each by the 72 slides. Although the relationship between slide types and outcomes was random, subjects in all three experiments overestimated the co-occurrence of shock and blood-injury slides relative to all other slide-outcome combinations. However, there was no significant effect of blood-injury fear on this bias, indicating that, regardless of their blood-injury fear level, humans show an associative bias to selectively associate blood-injury stimuli with aversive outcomes.

Fear-relevant illusory correlations: what types of associations promote judgmental bias?

A. J. Tomarken, S. Mineka, and M. Cook (1989) found that high-fear individuals markedly overestimated the covariation between fear-relevant stimuli and aversive outcomes. The authors assessed what features of stimulus-outcome associations promote illusory correlations. In Experiment 1, participants with high snake fear exhibited significant covariation bias for slides of snakes and shocks, but not for slides of damaged electric outlets (DEOs) and shocks. In Experiment 2, individuals with high and low snake fear rated DEOs and shocks as belonging together better than snakes and shocks. However, the shapes of high-fear individuals' affective response profiles to snakes and shocks were more similar than their profile shapes involving other pairings. In addition, their affective responses to snakes and snake-shock profile similarity predicted snake-shock belongingness ratings. These results suggest the importance of emotional responses and emotional profile similarity in mediating illusory correlations involving fear-relevant stimuli.

Temperament, personality, and the mood and anxiety disorders.

Literature on temperament, personality, and mood and anxiety disorders is reviewed. The review is organized primarily around L. A. Clark and D. Watson's (1991b) tripartite model for these disorders, but other influential approaches are also examined. Negative affectivity (or neuroticism) appears to be a vulnerability factor for the development of anxiety and depression, indicates poor prognosis, and is itself affected by the experience of disorder. Positive affectivity (or extraversion) is related more specifically to depression, may be a risk factor for its development, suggests poor prognosis, and also may be affected by the experience of disorder. Other personality dimensions (e.g., anxiety sensitivity, attributional style, sociotropy or dependence, autonomy or self-criticism, and constraint) may constitute specific vulnerability factors for particular disorders. More longitudinal and measurement-based research that jointly examines anxiety and depression is needed.

Mechanisms involved in the observational conditioning of fear.

Three experiments support the hypothesis that mechanisms involved in observational conditioning (OC) of fear are similar to those of direct classical conditioning and involve the organism attempting to detect the causal structure of its environment. Experiment 1, a correlational analysis, shows that model monkeys' fear behaviors on snake trials (unconditioned stimulus [US]) were highly correlated with observer monkeys' fear (unconditioned response) while watching the models' fear. In Experiment 2, all observers showed distress while watching the model's fear during Session 1 of OC, but only observers who could see the snake to which the model was reacting continued to show fear during subsequent OC sessions, suggesting that the model's fear is an easily habituable US. In Experiment 3, observers acquired significant fear of snakes after 1 OC session, indicating that the continued fear of those Experiment 2 observers that could see the snake may reflect their own acquired fear of snakes.

Selective associations in the observational conditioning of fear in rhesus monkeys.

Three experiments explored the issue of selective associations in the observational conditioning of fear. Experiment 1 results indicated that observer rhesus monkeys acquired a fear of snakes through watching videotapes of model monkeys behaving fearfully with snakes. In Experiment 2, observers watched edited videotapes that showed models reacting either fearfully to toy snakes and nonfearfully to artificial flowers (SN+/FL-) or vice versa (FL+/SN-). SN+/FL- observers acquired a fear of snakes but not of flowers; FL+/SN- observers did not acquire a fear of either stimulus. In Experiment 3, monkeys solved complex appetitive discriminative (PAN) problems at comparable rates regardless of whether the discriminative stimuli were the videotaped snake or the flower stimuli used in Experiment 2. Thus, monkeys appear to selectively associate snakes with fear.

Fear-relevant selective associations and covariation bias.

Three experiments used an illusory correlation paradigm to assess the effects of fear on the perception of the covariation between fear-relevant stimuli and shock. In Experiment 1, high- and low-fear women were exposed to 72 trials during each of which a fear-relevant (snake or spider) or fear-irrelevant (mushroom and flower) slide was followed by a shock, a tone, or nothing. Although the relation between slide types and outcomes was random, high-fear subjects markedly overestimated the contingency between feared slides and shock. Experiment 2 showed that this bias was due to the aversive, rather than more generally salient, features of shock. Low-fear subjects demonstrated biases equivalent to those of high-fear subjects only when the base rate of shock was increased from 33% to 50% in Experiment 3. It is concluded that fear may be linked to biases that serve to confirm fear. The relevance of the present findings to preparedness theory is also discussed.

Observational conditioning of fear to fear-relevant versus fear-irrelevant stimuli in rhesus monkeys.

Two experiments examined whether superior observational conditioning of fear occurs in observer rhesus monkeys that watch model monkeys exhibit an intense fear of fear-relevant, as compared with fear-irrelevant, stimuli. In both experiments, videotapes of model monkeys behaving fearfully were spliced so that it appeared that the models were reacting fearfully either to fear-relevant stimuli (toy snakes or a toy crocodile), or to fear-irrelevant stimuli (flowers or a toy rabbit). Observer groups watched one of four kinds of videotapes for 12 sessions. Results indicated that observers acquired a fear of fear-relevant stimuli (toy snakes and toy crocodile), but not of fear-irrelevant stimuli (flowers and toy rabbit). Implications of the present results for the preparedness theory of phobias are discussed.