Adjustment to chronic obstructive pulmonary disease: the importance of psychological factors.

Research has indicated a weak relationship between the degree of physical problems and quality of life in patients with chronic obstructive pulmonary disease (COPD). The importance of adaptive psychological functioning to maintain optimum quality of life has long been recognized, but there is a lack of empirical evidence concerning the nature of psychological factors involved in adjustment to COPD. Ninety-two males completed questionnaires to determine their coping strategies, levels of self-efficacy of symptom management and social support. Adjustment was measured in terms of depression, anxiety and quality of life. Symptom severity, socioeconomic status, duration of disease and age, which have been demonstrated to be of consequence in COPD, were used as control variables in hierarchical multiple regression analyses. Higher levels of catastrophic withdrawal coping strategies and lower levels of self-efficacy of symptom management were associated with higher levels of depression, anxiety and a reduced quality of life. Higher levels of positive social support were linked to lower levels of depression and anxiety, while higher levels of negative social support were linked to higher levels of depression and anxiety. To maximize quality of life in patients with chronic obstructive pulmonary disease, psychological factors need to be carefully assessed and addressed.

The structure of anxiety symptoms among preschoolers.

This study examined whether anxiety symptoms in preschoolers reflect subtypes of anxiety consistent with current diagnostic classification systems, or should be better regarded as representing a single dimension. Parents of a large community sample of preschoolers aged 2.5 to 6.5 years rated the frequency with which their children experienced a wide range of anxiety problems. Exploratory factor analysis indicated four or five factors and it was unclear whether separation anxiety and generalized anxiety represented discrete factors. Results of confirmatory factor analyses indicated a superior fit for a five-correlated-factor model, reflecting areas of social phobia, separation anxiety, generalized anxiety, obsessive-compulsive disorder and fears of physical injury, broadly consistent with DSM-IV diagnostic categories. A high level of covariation was found between factors, which could be explained by a single, higher order model, in which first order factors of anxiety subtypes loaded upon a factor of anxiety in general. No significant differences were found in prevalence of anxiety symptoms across genders. Symptoms of PTSD in this sample were rare.

An investigation of symptom-specific muscle hyperreactivity in upper extremity cumulative trauma disorder.

OBJECTIVE: The study examined symptom-specific muscle hyperreactivity in patients with chronic pain with upper limb cumulative trauma disorder (CTD). DESIGN: Four tasks were presented in counterbalanced order and included neutral, general stressor, personal stressor, and pain stressor tasks. Ratings of stressfulness and recordings of skin conductance level confirmed the effectiveness of the experimental manipulations in inducing stress experiences for all subject groups. SETTING: The study was conducted in a university research center. PATIENTS: Thirty patients with CTD were matched as closely as possible for age and gender to control groups of chronic low back pain, arthritis, and pain-free subjects. OUTCOME MEASURES: Surface electromyograph recordings were taken from the frontalis, forearm flexors, trapezius, and lower back during baseline and tasks. RESULTS: The study found no evidence of greater muscle tension increases or extended duration of return to baseline for the CTD or low back pain patients at any of the muscle sites for any of the tasks in comparison to control groups. CONCLUSIONS: The results indicate that symptom-specific psychophysiological responses may be limited to certain subgroups rather than being characteristic of chronic musculoskeletal pain patients in general.

The treatment of childhood social phobia: the effectiveness of a social skills training-based, cognitive-behavioural intervention, with and without parental involvement.

Fifty children aged 7-14 years with a principal diagnosis of social phobia were randomly assigned to either child-focused cognitive-behaviour therapy (CBT), CBT plus parent involvement, or a wait list control (WLC). The integrated CBT program involved intensive social skills training combined with graded exposure and cognitive challenging. At posttreatment, significantly fewer children in the treatment conditions retained a clinical diagnosis of social phobia compared to the WLC condition. In comparison to the WLC, children in both CBT interventions showed significantly greater reductions in children's social and general anxiety and a significant increase in parental ratings of child social skills performance. At 12-month follow-up, both treatment groups retained their improvement. There was a trend towards superior results when parents were involved in treatment, but this effect was not statistically significant.

Prevention of childhood anxiety disorders.

Anxiety disorders represent one of the most common and debilitating forms of psychopathology in children. While empirical research, mental health funding, and mental health professionals continue to focus on the treatment rather than prevention of anxiety disorders in children, preliminary research presents an optimistic picture for preventative strategies in the future. Knowledge of the risk factors, protective factors, and treatment strategies associated with childhood anxiety disorders, in conjunction with theories regarding the methods, timing, levels, and targets of prevention, equip us well for effectively preventing childhood anxiety disorders in the future.

Social skills, social outcomes, and cognitive features of childhood social phobia.

Social skills, social outcomes, self-talk, outcome expectancies, and self-evaluation of performance during social-evaluative tasks were examined with 27 clinically diagnosed social phobic children ages 7-14 and a matched nonclinical group. Results showed that, compared with their nonanxious peers, social phobic children demonstrated lower expected performance and a higher level of negative self-talk on social-evaluative tasks. In addition, social phobic children showed social skills deficits as assessed by self- and parent report, an assertiveness questionnaire, and direct behavioral observation. Furthermore, compared with the control group, social phobic children were rated by themselves and others as significantly less socially competent with peers and were found to be less likely to receive positive outcomes from peers during behavioral observation. Implications for the assessment and treatment of childhood social phobia are discussed.

Anxious children and their parents: what do they expect?

Assigned 73 children, ages 7 to 14, to 1 of 3 groups (anxious, clinical control, and nonclinical control) according to their diagnostic status. Within the anxious group, children were assigned to 1 of 2 further groups on the basis of self-reported parental anxiety--either the child anxiety only group or the child + parent anxiety group. All children completed an experimental task (giving a brief talk in front of a video camera), which was the focus for a series of structured family discussions between the child and his or her parents. The aims of the study were to measure and compare across groups (a) the evaluations of children and their parents regarding the child's predicted anxiety and skill level and (b) the effect of the family discussion on children's expectations. Results indicated that, prior to the family discussion, anxious children's expectations of their future performance did not differ from those of control children. Similarly, there were no differences in children's expectations between the child anxiety group and the child + parent anxiety group. Second, compared to mothers in the child anxiety group, mothers in the child + parent anxiety group expected that their children would be more anxious and more likely to choose an avoidant problem solution (but not less skilled). Finally, the family discussion was found to produce no changes in anxious children's expectations of their future performance. The implications of these findings are discussed.

The relative efficacy and treatment distress of EMDR and a cognitive-behavior trauma treatment protocol in the amelioration of posttraumatic stress disorder.

The growing body of research into treatment efficacy with Posttraumatic Stress Disorder (PTSD) has, by-and-large, been limited to evaluating treatment components or comparing a specific treatment against wait-list controls. This has led to two forms of treatment, Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavior Therapy (CBT), vying for supremacy without a controlled study actually comparing them. The present research compared EMDR and a CBT variant (Trauma Treatment Protocol; TTP) in the treatment of PTSD, via a controlled clinical study using therapists trained in both procedures. It was found that TTP was both statistically and clinically more effective in reducing pathology related to PTSD and that this superiority was maintained and, in fact, became more evident by 3-month follow-up. These results are discussed in terms of past research. Directions for future research are suggested.

Early intervention and prevention of anxiety disorders in children: results at 2-year follow-up.

The Queensland Early Intervention and Prevention of Anxiety Project evaluated a child- and family-focused group intervention for preventing anxiety problems in children. This article reports on 12- and 24-month follow-up data to previously reported outcomes at posttreatment and at 6-month follow-up. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After diagnostic interviews, 128 children were selected and assigned to either a 10-week school-based child- and parent-focused psychosocial intervention or a monitoring group. Both groups showed improvements immediately at postintervention and at 6-month follow-up; the improvement was maintained in the intervention group only reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. At 12 months, the groups converged, but the superiority of the intervention group was evident again at 2-year follow-up. Severity of pretreatment diagnoses, gender, and parental anxiety predicted poor initial response to intervention, whereas pretreatment severity was the only predictor of chronicity at 24 months. Overall, follow-up results show that a brief school-based intervention for children can produce durable reductions in anxiety problems.

A measure of anxiety symptoms among children.

The Spence Children's Anxiety Scale (SCAS) is a child self-report measure designed to evaluate symptoms relating to separation anxiety, social phobia, obsessive-compulsive disorder, panic-agoraphobia, generalized anxiety and fears of physical injury. The results of confirmatory and exploratory factor analyses supported six factors consistent with the hypothesized diagnostic categories. There was support also for a model in which the 1st-order factors loaded significantly on a single 2nd-order factor of anxiety in general. The internal consistency of the total score and subscales was high and 6 month test-retest reliability was acceptable. The SCAS correlated strongly with a frequently used child self-report measure of anxiety. Comparisons between clinically anxious and control children showed significant differences in total SCAS scores, with subscale scores reflecting the type of presenting anxiety disorder of the clinical samples.

The role of parental anxiety in the treatment of childhood anxiety.

Sixty-seven children aged 7 to 14 who met diagnostic criteria for an anxiety disorder were assigned to conditions according to parental anxiety level. Within these conditions, children were randomly assigned to 1 of 2 treatments: child-focused cognitive-behavioral therapy (CBT) or child-focused CBT plus parental anxiety management (CBT + PAM). At posttreatment, results indicated that within the child-anxiety-only condition, 82% of the children in the CBT condition no longer met criteria for an anxiety disorder compared with 80% in the CBT + PAM condition. Within the child + parental anxiety condition, 39% in the CBT condition no longer met criteria compared with 77% in the CBT + PAM condition. At follow-up, these differences were maintained, with some weakening over time. Results were not consistent across outcome measures. The interpretation and potential clinical implications of these findings are discussed.

Prevention and early intervention for anxiety disorders: a controlled trial.

The Queensland Early Intervention and Prevention of Anxiety Project evaluated the effectiveness of a cognitive-behavioral and family-based group intervention for preventing the onset and development of anxiety problems in children. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After recruitment and diagnostic interviews, 128 children were selected and assigned to a 10-week school-based child- and parent-focused psychosocial intervention or to a monitoring group. Both groups showed improvements immediately postintervention. At 6 months follow-up, the improvement maintained in the intervention group only, reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. Overall, the results showed that anxiety problems and disorders identified using child and teacher reports can be successfully targeted through an early intervention school-based program.

Structure of anxiety symptoms among children: a confirmatory factor-analytic study.

This study examined the degree to which anxiety symptoms among children cluster into subtypes of anxiety problems consistent with Diagnostic and Statistical Manual of Mental Disorders (4th edition) classification of anxiety disorders. Two community samples of 698 children 8-12 years of age completed a questionnaire regarding the frequency with which they experienced a wide range of anxiety symptoms. Confirmatory factor analysis of responses from Cohort 1 indicated that a model involving 6 discrete but correlated factors, reflecting the areas of panic-agoraphobia, social phobia, separation anxiety, obsessive-compulsive problems, generalized anxiety, and physical fears, provided an excellent fit of the data. The high level of covariance between latent factors was satisfactorily explained by a higher order model in which each 1st-order factor loaded on a single 2nd-order factor. The findings were replicated with Cohort 2 and were equivalent across genders.

Performance realism in test-anxious students.

Abstract Twenty-four high test-anxious and 24 low test-anxious students completed two cognitive tasks under either high or low performance demand manipulations. Before each task subjects rated anxiety levels and performance expectations, with performance evaluations being conducted following completion of each task. Results revealed lower actual, anticipated and self-evaluated performance scores for high test-anxious students compared to their low test-anxious counterparts. Expected and self-evaluated performance ratings were then compared with actual performance. No difference was found between high and low test-anxious subjects in terms of the discrepancy between expected and actual performance. Both groups of students tended to be overoptimistic in their performance predictions. However, following the first cognitive task the test-anxious group demonstrated accurate self-evaluation, whereas the low test-anxious group were overoptimistic in their self-evaluation. This effect was not found for the second task, on which both groups were accurate in their performance-evaluation. The results are discussed in terms of cognitive theories of anxiety, self-focussed attention and realism amongst test-anxious students.

The role of autonomic arousal in problem gambling.

The present study investigated the role of arousal in problem gambling. Three groups of subjects were recruited into the study corresponding to problem gamblers, high and low frequency social gamblers. For the two gambling groups, the preferred form of gambling was poker machine playing. Five different conditions were employed in order to determine under which conditions gambling related cues were related to increased autonomic arousal, as measured by skin conductance level (SCL), heart rate (HR) and frontalis electromyography (EMG). The five conditions were a neutral task, a videotaped poker machine gambling scenario presented with and without distraction, a personally relevant "win" situation and a videotaped horse race. Comparisons between responses for the videotaped poker machine gambling stimuli versus a horse-racing video task demonstrated differences only for the problem gambling group and only for SCL. No differences between these tasks emerged on the HR and EMG indices and no differences were evident for either of the social gambling groups. No changes were observed in any group when subject's cognitions were prevented by asking patients to count the number of wins made during the video play period while watching the same poker machine video. However, when personally relevant situations were presented and compared to a neutral task, differences were observed in all three groups. However, the nature of these differences varied between the groups and the different indices of arousal. For problem gamblers, increases were evident in all three measures. Increases were also observed for the control groups in comparison to the neutral task, but only in HR and SCL and not for EMG. For HR, the increases were equivalent across all three gambling groups. However, for SCL the problem gambling group became significantly more aroused than the control groups, but no differences were observed between the high and low frequency gamblers. Only the problem gambling groups evidenced significant increases in the personally relevant task compared to the neutral task for EMG. Theoretical and clinical implications of these results for the development, maintenance and treatment of problematic levels of gambling are discussed.

Cognitive-behavioural therapy versus EMG biofeedback in the treatment of chronic low back pain.

Forty-four chronic, but relatively well functioning, low back pain patients were assigned to either Cognitive Behaviour Therapy (CBT). Electromyographic Biofeedback (EMGBF) or Wait List Control (WLC). Both treatments were conducted over eight sessions in groups of four subjects. Results at post-treatment indicated significant improvements in functioning on measures of pain intensity, perceived level of disability, adaptive beliefs about pain and the level of depression in both the CBT and EMGBF conditions. These improvements were not evident for the WLC condition. At 6 months follow-up, treatment gains were maintained in the areas of pain intensity, pain beliefs, and depression, for both treatment groups, with further improvements occurring in anxiety and use of active coping skills. No significant differences were found between CBT and EMGBF on any of the outcome measures at either post-treatment or at 6 months follow-up. Further research is required to determine the degree to which these results reflect the mild level of psychological impairment and disability status of patients in the present study.

Cognitive therapy with children and adolescents: from theory to practice.

Cognitive therapies are now well established as a component for the treatment of a wide range of child behaviour problems. There is a great deal of evidence to suggest that deficits and distortions in cognitive processes play a role in disorders of affect and behaviour in children and adults alike. This has led to the development of many different cognitive therapy approaches which aim to influence cognitive products, structures and operations. Cognitive assessment methods continue to lag behind the developments in therapy, and there is a marked need for the development of reliable and valid measures. Empirical studies support the value of cognitive interventions, although it is recognised that most cognitive therapies include aspects of behavioural techniques, making it difficult to draw valid conclusions. Certainly, the results of recent meta-analytic studies have produced optimistic conclusions and justify the continued use of cognitive therapy methods in clinical practice, with a wide range of behavioural problems. Cognitive therapy techniques have something to offer with internalising and externalising disorders alike. Future research should now focus on the identification of methods to enhance the effects of cognitive therapies and to determine the characteristics of children who are most likely to benefit from these methods. There is some evidence to suggest that younger children may benefit less from cognitive therapies than do adolescents. This perhaps reflects differences in cognitive and language development. Further consideration needs to be given to adapting cognitive therapy methods to the developmental level of younger children. Cognitive therapy approaches are now well entrenched within many multi-component programmes for most emotional and behavioural disorders in children. The degree to which cognitive therapies add to the effectiveness of behavioural methods, however, remains to be demonstrated for many types of behaviour problem. It is also unclear whether the changes in affect and overt behaviour produced in these intervention programmes is actually related to improvements in the cognitive activities that were targeted in therapy. From a theoretical perspective, however, cognitive therapies have a high degree of face validity. If deficits or excesses in specific cognitive events or processes are found during assessment, which can be hypothesised to underlie disturbances of affect of behaviour, then there is a strong case for attempting to change these aspects of cognition.

The effectiveness of cognitive self-management as an adjunct to a behavioural intervention for childhood obesity: a research note.

This study investigated the effectiveness of cognitive self-management training as an adjunct to the behavioural management of childhood obesity. Twenty-seven overweight children aged 7-13 years were randomly assigned to either behavioural management plus relaxation placebo or a combined behavioural-cognitive self-management approach. Evaluations following the eight treatment sessions revealed a significant reduction in percentage overweight for children in both experimental groups and improvements were maintained at 3- and 6-month follow-ups. Both conditions were also effective in reducing the number of high-risk foods consumed. No difference in outcome was found between treatments at the post-treatment assessment or 3- and 6-month follow-ups. Although a reduction in percentage overweight of around 9% was found for both procedures, subjects in general remained considerably overweight.

The stability of fears in children: a two-year prospective study: a research note.

This study investigated the stability of self-reported fears amongst 94 primary school children over a 2-year period using the Fear Survey Schedule for Children--Revised (FSSC--R). Children reported a decrease in fearfulness with increasing age, with girls reporting higher fear scores than boys on both occasions. The most frequently feared stimuli were almost identical for boys and girls and remained the same on both occasions, relating mainly to fears of danger, death and physical injury. Those fears that showed the greatest reduction over time concerned getting sick, parental criticism or punishment and the dark for girls, whereas boys reported the greatest reductions in fears relating to physical injury, parental criticism, the dark and unfamiliar persons. The only fear stimulus to increase with age was "giving a spoken report", which was rated as more fearful by boys on the second occasion. Children identified as unusually fearful at Time 1, were much more likely to report high fear levels two years later, compared to children who did not report high fear levels at Time 1.

Site-specific muscle hyper-reactivity in musicians with occupational upper limb pain.

Fourteen musicians who reported a history of pain in the upper limb associated with the playing of their instruments were compared with a sample of pain-free musicians, matched for age, sex and musical instrument. Four tasks were presented in random order and included neutral, general stressor, personal stressor and pain stressor tasks. Ratings of stressfulness and recordings of skin conductance level confirmed the effectiveness of the experimental manipulations for both subject groups. No differences were found between groups or tasks for frontalis surface electromyograph (EMG) activity. Evidence was found, however, of EMG elevation in flexor and trapezius muscles on the pain side for the pain subjects, in response to the task involving recall of a pain experience. This elevation was not found for the pain-free controls or for other stressor tasks, although some elevation in response to the pain stressor task was found for pain subjects in the trapezius muscles of the non-pain side. The duration of return to baseline of EMG following the pain stressor task was found to be extended in pain subjects for the trapezius, but not for the flexor muscles of the pain side. The findings suggest that site-specific muscle hyper-reactivity may play a role in the development and maintenance of occupational upper limb pain in musicians.