Search PubMed⌕ Search

Biomedical subjects

B J Cox

Publications and source records attributed to B J Cox.

At least 55 records · Page 3Linked to original sources
PubMed1996

Posttraumatic stress disorder and motor vehicle accidents: a multidisciplinary overview.

OBJECTIVE: Motor vehicle accidents (MVA) may result in intractable disability. This paper investigates posttraumatic stress disorder (PTSD) as a potential cause. METHOD: The literature was reviewed for recent studies on prevalence, symptom profile, and outcome of PTSD. RESULTS: PTSD is prevalent in roughly 10% of survivors of MVAs during the first year. Comorbid depression and pain are common. Medical complications, psychophysiological reactivity, and possibly litigation may slow remission. Phobic symptoms can persist for years. Mood disturbance may augment the impact of pain on daily living and on self-perceived disability. CONCLUSION: Recently developed screening instrument, structured interviews, and behavioural approach tests yield quantitative and reliable assessments of symptom severity. Cognitive-behavioural intervention and antidepressants may improve coping, ease fear, and reduce the impact of pain.

Accidents, Traffic↗
PubMed1996

Confirmatory factor analysis of the Fear Questionnaire with social phobia patients.

BACKGROUND: The Fear Questionnaire is an internationally popular measure in anxiety disorder research, but its validity with social phobia patients has not been clearly demonstrated. METHOD: A confirmatory factor analysis was conducted using the Fear Questionnaire responses of 122 social phobia patients. RESULTS: The results indicated that the proposed three-factor model of the scale (agoraphobia, social phobia, and blood/injury dimensions) provided a good fit to the data. CONCLUSIONS: These data provide strong support for the validity of the scale and for the multidimensional view of fears proposed by Arrindell.

Adult↗
PubMed1995

An examination of levels of agoraphobic severity in panic disorder.

Based on the results of previous studies, several factors believed to be related to the development of agoraphobia were simultaneously assessed in 195 panic disorder patients (57 males, 138 females) with various levels of DSM-III-R-defined agoraphobia: none, mild, moderate, or severe. The four groups of patients significantly differed from each other on self-reports of phobic avoidance, although all the groups reported a similar type of panic attack. The four groups also did not significantly differ on catastrophic panic cognitions (e.g. fear of dying), fear of anxiety symptoms (anxiety sensitivity), or variables related to spontaneous panic. Neither severity or frequency of panic was predictive of severity of agoraphobia. The anticipation of panic only in relation to agoraphobic situations was predictive of severity of agoraphobia, followed by perceived lifestyle restrictions due to panic, and trait anxiety regarding ambiguous or novel situations. Regardless of level of agoraphobia, patients tended to avoid situations where they anticipated panic would occur, indicating that panic and agoraphobia do not share a unique or exclusive relationship. Panic disorder with various levels of phobic avoidance, rather than just agoraphobia, would appear to be a more valid diagnostic category.

Adaptation, Psychological↗
PubMed1995

Efficacy of telephone-administered behavioral therapy for panic disorder with agoraphobia.

The purpose of this study was to determine the efficacy of a structured exposure-based behavior therapy program delivered by telephone to agoraphobic individuals who were isolated from specialized treatment centres. Forty-two individuals with a DSM-III-R diagnosis of panic disorder with agoraphobia who were living in rural areas of Ontario were assigned to either an eight-session telephone behavior therapy program or wait-list control condition. There were significant treatment x time interaction effects on several outcome variables. Patients originally in the wait-list group then received the same type of therapy and they also significantly improved. All treatment gains were maintained at three-month and six-month follow-up. Telephone behavior therapy appears to be a cost-effective and efficacious treatment for agoraphobics living in remote regions where specialized anxiety disorder services are not readily available.

Adult↗
PubMed1995

Phobic dimensions--II. Cross-national confirmation of the multidimensional structure underlying the Mobility Inventory (MI).

In a previous study (Cox, Swinson, Kuch & Reichman, Behaviour Research and Therapy, 31, 427-431, 1993), factor analyses of the responses of 177 Canadian panic disorder with agoraphobia patients to the 'When Accompanied' and 'When Alone' scales of the Mobility Inventory (Chambless, Caputo, Jasin, Gracely & Williams, Behaviour Research and Therapy, 23, 35-44, 1985) revealed three factors in each case: Fears of (1) Public places; (2) Enclosed spaces; and (3) Open spaces. Using two distinct methods of factorial analysis, evidence was found for the cross-national generalizability of the factor model when the responses of Dutch members of a society for individuals suffering from an anxiety disorder (N = 213) were contrasted with the original Canadian findings. Inventory items were distributed in a non-overlapping fashion across the corresponding three subscales. Psychometric properties of the subscales were encouraging, although some difficulties emerged when attempts were made at distinguishing Fears of Enclosed spaces from Fears of Open spaces. This was because of their correlational configurations with other measures. Scores on all scales varied with socioeconomic status (SES); Ss in lower SES groups had significantly higher agoraphobic avoidance scores than their equivalents in higher SES groups. Results of higher-order analysis, which included several state and trait measures of psychological functioning in addition to the Mobility Inventory, revealed two orthogonal, second-order factors which were interpreted as Agoraphobia and Neuroticism/Negative Affect vs Positive Affect. Implications for further studies are briefly outlined.

Adult↗
PubMed1995

Anxiety sensitivity and panic attack symptomatology.

The relationship between 23 specific panic attack symptoms and the 16 items of the Anxiety Sensitivity Index was investigated using a factor analytic procedure with a large sample (N = 209) of panic disorder patients. A five-factor model resulted in three panic symptom clusters (cardio-respiratory, dizziness-related, and cognitive symptoms) and two anxiety sensitivity factors (fear of physical symptoms and fear of psychological symptoms). The five-factor model accounted for 50% of the variance. There was some overlap between anxiety sensitivity and panic symptomatology and the cognitive panic symptom "fear of dying" loaded strongly on the anxiety sensitivity fear of physical sensations factor rather than on any of the panic symptoms factors. These results demonstrate that anxiety sensitivity can be independent of panic and are also consistent with a cognitive view of panic in which catastrophic cognitions that occur during a panic attack are more associated with a cognitive style or personality trait than with the severity of physical symptoms.

Adult↗
PubMed1994

A comparison of three assessment instruments for obsessive-compulsive symptoms.

The psychometric characteristics and relationship among the Leyton Obsessional Inventory, Maudsley Obsessional-Compulsive Inventory, and Yale-Brown Obsessive-Compulsive Scale were examined in a sample of 30 obsessive-compulsive patients diagnosed using a structured interview. The majority of the subscales of the various measures were found to have good internal consistency across gender and the mean scores were similar to those reported in other studies. There were also moderate correlations between several of the measures and clinician ratings of depression. The results suggest that (1) gender differences should be further explored in future research (2) caution should be used when extrapolating the results of treatment studies that use different OCD measures, and (3) a measure of depression should always be included in OCD studies to control for the possible effects of depressed mood.

Adult↗
PubMed1994

Levels of "nonclinical panic".

Many individuals experience DSM-III-R-defined panic attacks but do not seek treatment--"nonclinical panic". However, there is a substantial range in the frequency of panic attacks reported by these individuals. The present study compared 35 frequent panickers (panic in a 3-week period), 50 infrequent panickers (panic in the past year only), and 267 nonpanickers (no lifetime history of panic) on several measures of psychopathology and panic attack characteristics. Only the frequent panickers had significantly elevated levels of self-reported psychopathology and phobic avoidance compared to nonpanickers, and the three groups of subjects differed significantly on anxiety sensitivity scores. Frequent and infrequent panickers reported similar panic attack characteristics. Overall, the results strongly suggest that only frequent panickers exemplify the anxiety state referred to as "nonclinical panic."

Adolescent↗
PubMed1994

Overprediction of fear in panic disorder with agoraphobia.

The overprediction of fear model is discussed in relation to the development and maintenance of panic disorder with agoraphobia. Data are presented which demonstrate a significant relationship between self-reports of phobic avoidance and anticipation of panic, both before and after treatment, and the occurrence of panic. Implications of the overprediction model for exposure-based therapy are also discussed along with its limitations and some directions for future research.

Adult↗
PubMed1994

Precipitating events, locations and reactions associated with initial unexpected panic attacks.

This study examined the phenomenology of the initial panic attack in 85 panic disorder patients with or without agoraphobia. Patients were divided into minimal and extensive avoiders and three domains were assessed: precipitating factors, location of initial panic, and reaction to the panic. No apparent precipitating factor could be identified in approx 40% of the patients. The most common precipitants were injury/illness and interpersonal conflict. Extensive avoiders were more likely to have experienced the initial panic in classic agoraphobic situations. Public transportation was the most common location for the total sample. In reaction to the panic, minimal avoiders were more likely to have gone to a hospital emergency room (ER) whereas extensive avoiders were more likely to have done nothing in terms of help-seeking. Many patients with either minimal or extensive avoidance avoided the locations where the initial panic occurred, suggesting that circumscribed avoidance does not always generalize.

Adult↗
PubMed1994

Social desirability and self-reports of alcohol abuse in anxiety disorder patients.

Previous research has shown there is significant comorbidity between alcohol abuse and anxiety disorders. However, the prevalence of anxiety disorders in alcoholic samples has been found to be higher than the occurrence of alcohol abuse in anxiety disorder samples. One possibility for this apparent discrepancy involves a social desirability response bias where it may be less socially acceptable to report alcoholism than to report an anxiety disorder. Thus, a high need for social approval may be associated with minimizing alcohol abuse. The relationship between standardized self-reports of alcohol abuse and social desirability was assessed in 51 panic disorder (PD) and 33 social phobia (SP) patients. In male PD patients there was a negative correlation (-0.46) between social desirability and self-reports of alcohol abuse that approached statistical significance, and the prevalence of alcohol abuse was 18%. In male SP patients there was no such inverse relation and the prevalence of alcohol abuse was much higher (47%). In female anxiety disorder patients these patterns were not evident. These results suggest that when there is a strong (negative) relationship between self-reports of alcoholism and social desirability, the alcohol use may be minimized. In general, however, this relationship was not pronounced in most anxiety disorder patients.

Adult↗
PubMed1994

Alexithymia in somatoform disorder patients with chronic pain.

The prevalence of alexithymia in fifty-five motor vehicle accident survivors who had chronic pain complaints and met DSM-III-R criteria for somatoform pain disorder was 53%. Alexithymic and non-alexithymic patients did not differ on self-reports of current pain severity or in the number of pain locations. Alexithymic patients were found to use significantly more words to describe their pain, suggesting they may have a more diffuse style in communicating their pain experience.

Accidents, Traffic↗
PubMed1994

Suicidal ideation and suicide attempts in panic disorder and social phobia.

OBJECTIVE: Using the original National Institute of Mental Health Epidemiologic Catchment Area (ECA) suicide questions in a clinical setting and including a comparison group of patients with social phobia, the authors attempted to replicate the finding of Weissman and associates of a greater risk of suicidal ideation and suicide attempts associated with panic disorder. METHOD: One hundred six patients with panic disorder and 41 patients with social phobia answered the five ECA suicide questions and completed a psychometric assessment package at an anxiety disorders clinic. RESULTS: Thirty-three (31%) of the patients with panic disorder and 14 (34%) of the patients with social phobia reported suicidal ideation in the past year, but only one of the patients with panic disorder and two of the patients with social phobia actually made suicide attempts in the past year. Nineteen (18%) of the patients with panic disorder and five (12%) of the patients with social phobia reported making suicide attempts at other times in their lives. Patients who had made past suicide attempts were significantly more likely to report previous psychiatric hospitalizations and past treatment for depression than were patients who had never attempted suicide. CONCLUSIONS: These results are consistent with the findings of Weissman and associates that a large proportion of individuals with panic disorder report suicidal ideation. However, many patients with social phobia also reported suicidal ideation, and few individuals in either diagnostic group had actually made recent suicide attempts. Although 12%-18% of the patients reported lifetime suicide attempts, there is evidence to suggest that these were in the context of depressive symptoms.

Adult↗
PubMed1994

Citation patterns in anxiety disorders research in 14 journals: 1990-1991.

The authors reviewed the distribution of citations in 278 anxiety disorder studies published in 14 journals in 1990 and 1991. Although both psychiatrists and psychologists frequently authored studies, few journals showed evidence of a substantial interdisciplinary perspective. The 278 anxiety disorder studies contained 3,199 references to articles in the 14 journals. There was a high percentage of "self-citation" in some of the journals and only limited evidence of citations across journal and author disciplines. These findings suggest that anxiety disorder research findings are often not widely disseminated across disciplines.

Anxiety Disorders↗
PubMed1993

Clomipramine, fluoxetine, and behavior therapy in the treatment of obsessive-compulsive disorder: a meta-analysis.

The most common effective treatments for obsessive-compulsive disorder include clomipramine, fluoxetine, and exposure-based behavior therapy. A meta-analysis was conducted on the results from 25 appropriate treatment studies (1975-1991). All three treatments were significantly effective for most of the outcome variables (overall severity, anxiety, depression). Exposure was not significantly effective for reducing depressed mood. More treatment outcome studies are needed before a clearly superior treatment or combination of treatments can be statistically determined.

Behavior Therapy↗
PubMed1993

Gender effects and alcohol use in panic disorder with agoraphobia.

Previous studies have found some significant, but weak, gender differences in panic and agoraphobia with females generally being more symptomatic. The present study sought to expand this line of research by examining alcohol use and self-medication in relation to gender differences and measures of psychopathology. Seventy-four male and 162 female patients with panic disorder with agoraphobia were compared. There were some significant, but relatively small, gender differences with females reporting higher levels of phobic avoidance. Males reported significantly more weekly alcohol intake and also perceived alcohol to be a more effective strategy in coping with anxiety. Alcohol-related factors were significantly correlated with several measures of psychopathology for males but this was less evident in females. The correlations were not large but the results do suggest that a subset of males consume moderate to large amounts of alcohol, believe self-medication to be an effective anti-anxiety strategy, and yet report higher levels of psychopathology such as social fears.

Adult↗
PubMed1993

Dimensions of agoraphobia assessed by the Mobility Inventory.

Factor analyses of the When Accompanied and When Alone subscales of the Mobility Inventory (Chambless, Caputo, Jasin, Gracely & Williams, Behaviour Research and Therapy, 23, 35-44, 1985) were conducted using the responses of 177 panic disorder with agoraphobia patients. For both subscales a three-factor model was the most appropriate and accounted for approx. 60% of the variance in each case. The three factors were reliable and theoretically meaningful: fear of public places, enclosed spaces and open spaces. The fear of public places factor accounted for most of the explained variance and is discussed in relation to the social evaluation component of panic attacks.

Adult↗