What sensitivities matter in dental anxiety? Investigating sensitivity to anxiety, pain, and disgust.

Dental anxiety affects many people worldwide and interferes with oral health. Beyond emotional distress, avoidance of dental care visits can lead to serious dental and health consequences. Although emerging research implicates anxiety, pain, and disgust sensitivities in the etiology and maintenance of dental anxiety, no studies to date have concurrently investigated the unique contribution of these vulnerabilities in dental anxiety. As a step toward elucidating salient mechanisms of dental anxiety, the present study investigated the aggregate contribution of anxiety, pain, and disgust sensitivities in dental anxiety, after controlling for relevant covariates. In this study, participants (N = 717; 71.3% female) included an unselected sample of undergraduate students who completed a battery of online questionnaires. Consistent with community rates, 12% of this sample reported high levels of dental anxiety. The hierarchical regression model revealed anxiety and disgust sensitivities were positively associated with dental anxiety symptoms when adjusting for other model variables. Results highlight the roles of anxiety and disgust sensitivities in dental anxiety and indicate the potential benefit of targeting these emotional sensitivities through routine screenings and treatments for dentally anxious patients.

Development of a measure to assess acceptance of headache: The Headache Acceptance Questionnaire (HAQ).

BACKGROUND: Disability resulting from headache disorders is attributable in part to avoidant coping. Acceptance of pain connotes a willingness to experience pain in the service of life values, such that meaningful activities and goals are pursued despite pain. Acceptance facilitates positive health outcomes but has rarely been investigated in headache. Because headache disorders manifest differently than other forms of chronic pain, the present study sought to develop and validate a measure of acceptance of headache. METHODS: Forty-five candidate items were developed and, with input from an expert panel, reduced to 24 items. Five items were eliminated following administration to a development sample and exploratory factory analysis. Nineteen items were administered to a validation sample for confirmatory factory analysis and assessment of psychometric properties. RESULTS: Factor analysis produced a unidimensional six-item measure, the Headache Acceptance Questionnaire (HAQ). The HAQ evidenced good internal consistency, convergent validity with headache disability and related psychological constructs, and divergent validity with social desirability. The measure also distinguished between headache diagnostic groups. CONCLUSIONS: Pending further validation in clinical settings, the HAQ may have utility in assessing psychological responses to headache symptoms, identifying targets of treatment for interventions that focus on reducing avoidance, and studying mechanisms of change.

Development and psychometric investigation of an inventory to assess fight, flight, and freeze tendencies: the fight, flight, freeze questionnaire.

Fear is a psychological construct inherent in assessment of and reaction to threat. Its expression has been associated with individual differences in temperament, personality, and behavioral inhibition. Defining and subsequently assessing these individual differences in fear as a trait-like variable, however, have been largely neglected by researchers. Although there are well-established measures of fear, these primarily assess response to phobic stimuli rather than a reaction tendency to acute fear. As such, the goals of the present studies were to create, pilot, and revise a scale to assess the general construct of trait-like response to fear as it relates to underlying individual differences. Following guidelines for scale development, outlined by Haynes, Richard, and Kubany (1995 [Content validity in psychological assessment: A functional approach to concepts and methods. Psychological Assessment, 7, 238-247]) results of the current investigation provide strong, initial support for the factor structure, reliability, and construct validity of a new measure of trait-like fear: the Fight, Flight, Freeze questionnaire.

Behavioral inhibition and attentional network functioning.

The goal of the present study was to examine the interrelations between the sensitivity of the Behavioral Inhibition System (BIS) and attentional network functioning (i.e., the orienting, alerting, and executive attentional networks), with the aim of identifying a potentially relevant mechanism for understanding the relation between BIS sensitivity and the pathogenesis of anxiety and its disorders. To this end, 99 participants were recruited from the community and administered a questionnaire assessing BIS sensitivity, as well as the Attentional Network Test. Results demonstrated a significant association between BIS sensitivity and enhanced orienting attention. Further, BIS sensitivity predicted orienting attention above and beyond relevant covariates, including state negative affect. Results are discussed in terms of their implications for understanding the role of BIS sensitivity in the pathogenesis of pathological anxiety.

Maternal BIS Sensitivity, Overprotective Parenting, and Children's Internalizing Behaviors.

Although sensitivity to the Behavioral Inhibition System within Gray's (1970) reinforcement sensitivity theory relates to individuals' own depressive and anxious symptomatology, less is known about how parental BIS sensitivity relates to early indicators of internalizing problems in young children. Moreover, the extent to which this parental characteristic relates to parenting behavior, and children's internalizing problems above and beyond parenting, remains unknown. The current study assessed maternal BIS sensitivity, overprotective parenting, and toddlers' internalizing behaviors in a sample of 91 mothers while controlling for mothers' own internalizing symptomatology. Heightened BIS sensitivity related to both overprotective parenting and internalizing behaviors. Overprotective parenting partially mediated the relation between BIS sensitivity and children's internalizing behaviors, although BIS sensitivity maintained a marginal relation to internalizing behaviors. Maternal BIS sensitivity and toddler internalizing behaviors may represent a shared disposition towards inhibition that is somewhat accounted for by overprotective parenting.

The effects of safety behaviors on the fear of contamination: an experimental investigation.

The strategies used by anxious individuals to prevent feared outcomes, known as safety behaviors, are thought to maintain pathological anxiety by preventing the disconfirmation of inaccurate threat beliefs. However, it is possible that safety behaviors might also contribute to the development and exacerbation of anxiety symptoms. The present study tested this notion in a sample of undergraduate participants with either low (n=30) or high (n=26) levels of contamination fear. After a week-long baseline period, participants spent 1 week engaging in a clinically representative array of contamination-related safety behaviors on a daily basis, followed by a second baseline period. Subsequent to the safety behavior manipulation, participants evidenced statistically significant increases in threat overestimation, contamination fear symptoms, and emotional and avoidant responses to three contamination-related behavioral avoidance tasks (BATs). In contrast, anxiety and depressive symptoms remained stable. The magnitude of change in contamination concerns was equivalent among participants in both contamination fear groups. Our findings suggest that contamination-related safety behaviors elicit a modest and specific increase in the fear of contamination. Possible mechanisms for this effect, as well as implications for the role of safety behaviors in the psychopathology of anxiety disorders, are discussed.

A re-examination of the BIS/BAS scales: Evidence for BIS and BAS as unidimensional scales.

OBJECTIVES: Carver and White's behavioral inhibition system and behavioral activation system (BIS/BAS) scales are the most widely used to assess constructs of the revised reinforcement sensitivity theory. This study provides a re-examination of the latent structure of the original BIS/BAS scales. METHODS: The interpretability of the three purported BAS subfactors relative to a "general behavioral activation" factor was assessed using Schmid-Leiman and standard confirmatory factor analysis. Regarding the BIS scale, comparisons were made between (a) Carver and White's unidimensional BIS model, (b) Johnson, Turner, and Iwata's 2-factor BIS model, (c) Heym, Ferguson, and Lawrence's alternative 2-factor BIS model, and (d) a modified Heym et al. model (unidimensional) controlling for method effects of reverse-scored items. RESULTS: Results revealed the majority of variance of individual BAS items was accounted for by a common, general BAS dimension. Additionally, for the BIS scale, results of the χ2 difference statistical test supporting the 1-factor model, as well as the noted theoretical and psychometric difficulties in interpreting a multifactor BIS scale, provide converging support that BIS items actually represent a single, unidimensional factor. CONCLUSIONS: The collective results suggested that the BIS and BAS scales should be conceptualized as separate unidimensional measures, which is consistent with theory behind the original development.

Psychometric investigation of the specific phobia of vomiting inventory: A new factor model.

Well-validated, standardized measures are lacking for the assessment of emetophobia, the specific phobia of vomiting. The Specific Phobia of Vomiting Inventory (SPOVI) was recently developed and shows promise as a useful measure of emetophobia. The goal of the present study was to further examine and investigate the psychometric properties of the SPOVI in a large student sample (n = 1626), specifically focusing on its factor structure, measurement invariance across gender, and convergent/divergent validity. Confirmatory factor analysis results provide support for a one-factor model of the SPOVI, in contrast to the previously proposed two-factor model. Internal consistency of the SPOVI was good (α = 0.89) and measurement invariance across gender invariance was supported. The SPOVI also demonstrated good psychometric properties with respect to convergent and divergent validity. The present study's demonstration of the reliability and validity of the SPOVI suggests that the instrument may be a valuable tool for assessing emetophobia symptoms based on its one-factor structure.

The Development and Psychometric Investigation of the Cyberbullying Scale.

Accurate assessment of cyberbullying is essential for intervention planning and evaluation. Limitations to many currently available self-report measures of cyberbullying victimization include a lack of psychometric information and a limited scope (i.e., not assessing multiple electronic mediums of cybervictimization). To address these limitations, we developed and investigated the psychometric properties of a broad self-report measure of cyberbullying, the Cyberbullying Scale (CBS). We examined the factor structure and reliability of the CBS across 736 students in Grades 6 to 12 in six Northern Mississippi schools. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) results indicated that the structure of the CBS was best represented by a one-factor model. The finding of a single-factor structure suggests that cyberbullying is a unidimensional construct, which is consistent with previous research. In the current sample, the CBS demonstrated strong psychometric properties, including excellent internal consistency (Cronbach's α = .94) and significant positive correlations with related constructs of anxiety, depression, and loneliness. Results from the present study provide initial support for the CBS as a measure of cybervictimization among adolescents.

Exposure therapy for emetophobia: a case study with three-year follow-up.

Emetophobia, also referred to as a specific phobia of vomiting, is a largely under-researched and poorly understood disorder with prevalence estimates of ranging between 1.7 and 3.1% for men and 6 and 7% for women (Hunter & Antony, 2009; Philips, 1985). The current case study, therefore, sought to methodically apply exposure-based behavioral treatment to the treatment of a 26 year-old, Hispanic, female suffering from emetophobia. Although not as powerful as a randomized design, this description may still add to the existing emetophobia literature through the illustration of adaptation of published behavioral treatments for other specific phobias. The case presented was successful in terms of outcome, and includes a three-year follow up wherein treatment gains were measurably maintained.

Examining the incremental contribution of behavioral inhibition to generalized anxiety disorder relative to other Axis I disorders and cognitive-emotional vulnerabilities.

The goal of the present study was to investigate the incremental contribution of behavioral inhibition system (BIS) sensitivity to the presence of a current generalized anxiety disorder (GAD) diagnosis relative to other Axis I disorders (e.g., major depression, other anxiety disorders) and cognitive-emotional vulnerabilities (e.g., anxiety sensitivity, emotion dysregulation) previously found to be associated with GAD. Participants were 91 individuals recruited from the local community who completed a diagnostic interview and self-report questionnaires. Consistent with expectations, BIS sensitivity emerged as a significant predictor of current GAD status above and beyond major depression, anxiety disorder diagnoses, anxiety sensitivity, emotion dysregulation, and behavioral activation system sensitivity. However, emotion dysregulation also emerged as a significant predictor of GAD status in the final model. Findings speak to the importance of considering BIS sensitivity in models of the development and maintenance of GAD.

Indigenous perspectives on depression in rural regions of India and the United States.

Depression is a major health concern in India, yet indigenous Indian perspectives on depression have often been disregarded in favor of Western conceptualizations. The present study used quantitative and qualitative measures modeled on the Explanatory Model Interview Catalogue (EMIC) to elicit beliefs about the symptoms, causes, treatments, and stigma associated with depression. Data were collected from 92 students at a university in the Himalayan region of Northern India and from 97 students at a university in the Rocky Mountain region of the United States. U.S. participants in this study were included primarily to approximate a "Western baseline" (in which professional conceptions of depression are predominantly rooted) from which to elucidate Indian perspectives. Compared to U.S. participants, Indian participants were more likely to view restive symptoms (e.g., irritation, anxiety, difficulty thinking) as common features of depression, to view depression as the result of personally controllable causes (e.g., failure), to endorse social support and spiritual reflection or relaxation (e.g., yoga, meditation) as useful means for dealing with depression, and to associate stigma with depression. Efforts aimed at reducing depression among Indians should focus more on implementing effective and culturally acceptable interventions, such as yoga, meditation, and increasing social support.