Biomedical subjects

D L Chambless

Publications and source records attributed to D L Chambless.

At least 19 recordsLinked to original sources

PubMed2001

Predicting expressed emotion: a study with families of obsessive-compulsive and agoraphobic outpatients.

The authors used structural equation modeling to examine expressed emotion (EE) in relatives of outpatients with panic disorder with agoraphobia (n = 42) or obsessive-compulsive disorder (n = 60). EE was examined as a function of patients' illness and personality and as a function of characteristics of relatives themselves. EE was operationalized in terms of hostility on the Camberwell Family Interview (C. E. Vaughn & J. P. Leff, 1976) and patients' ratings of their relatives' criticism (perceived criticism). Key findings include the identification of a characteristic of the relative (self-reported angry thoughts, feelings, and behaviors) that is directly linked to both hostility toward the patient and to perceived criticism, as well as a direct path between relatives' low rates of observed problem solving and their hostility toward the patient. Patient Pathology predicted perceived criticism but not observer-rated hostility.

Adolescent↗

PubMed2001

Empirically supported psychological interventions: controversies and evidence.

Efforts to increase the practice of evidence-based psychotherapy in the United States have led to the formation of task forces to define, identify, and disseminate information about empirically supported psychological interventions. The work of several such task forces and other groups reviewing empirically supported treatments (ESTs) in the United States, United Kingdom, and elsewhere is summarized here, along with the lists of treatments that have been identified as ESTs. Also reviewed is the controversy surrounding EST identification and dissemination, including concerns abou research methodology, external validity, and utility of EST research, as well as the reliability and transparency of the EST review process.

Humans↗

PubMed2000

Factor analysis of the English version of the Kategoriensystem für Partnerschaftliche Interaktion [Interaction Coding System].

The Kategoriensystem für Partnerschaftliche Interaktion (KPI), or Interaction Coding System, is an observational coding system used to study behaviors occurring during dyadic interactions. The KPI offers several summary categories (e.g. positive, negative, neutral) to facilitate data analysis, but empirical evidence supporting these rationally derived groupings is lacking. Reported here are the results of a factor analysis of data obtained from 121 spouses or other close relatives of patients with anxiety disorders who participated in dyadic problem-solving interactions with the patients. A three-factor solution accounting for 50% of the variance emerged. The factors were Negativity, Problem-Solving Focus and Emotional Engagement. Confidence in the reliability of the first two factors is bolstered by their similarity to factors detected in prior research on a different coding system, the Marital Interaction Coding System.

Adult↗

PubMed2000

Relationship of cognitions to fear of somatic symptoms: a test of the cognitive theory of panic.

The relationship between fear of physical anxiety symptoms and cognitive misinterpretation of those symptoms, as measured by responses to the Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire, respectively, was examined for two samples of outpatients with panic disorder. Factor analytic and correlational analyses demonstrated that the patients' self-rated fear of specific physical and psychological symptoms was related to the frequency of specific logically related catastrophic thoughts (e.g., fears of heart palpitations or chest pressure with thoughts of a heart attack). This specific relationship between the somatic sensations and the catastrophic thoughts experienced by agoraphobic individuals provides further support for the cognitive theory of panic disorder. When the responses to the two questionnaires were factor-analyzed together, four factors were identified: symptoms and thoughts relevant to cardiovascular, neurological, gastrointestinal, and behavioral control systems, respectively. These findings suggest that the nature of panic-related fears varies across patients, and that the use of specific treatment interventions designed to modify the specific variations in their expression may be advisable.

Adult↗

PubMed2000

Convergent, discriminant, and criterion-related validity of the Social Phobia and Anxiety Inventory.

The psychometric properties of the Social Phobia Anxiety Inventory (SPAI) were assessed in a sample of participants who either had a primary diagnosis of social phobia or were normal volunteers. Positive evidence was obtained on the SPAI's concurrent and predictive convergent validity: it was significantly correlated with other measures of social anxiety obtained from self-report questionnaires of social impairment and with behavioral assessment measures administered in conjunction with a conversation role-play, including measures of negative thinking, subjective anxiety, and self-perceived skill and apparent nervousness. Discriminant validity was demonstrated by the SPAI's significantly stronger relationship with public than private self-consciousness. There was no overlap in SPAI scores in the normal volunteer and socially phobic groups, demonstrating criterion-related validity.

Adult↗

PubMed2000

EMDR for panic disorder with agoraphobia: comparison with waiting list and credible attention-placebo control conditions.

In a randomized controlled trial, eye movement desensitization and reprocessing (EMDR) for panic disorder with agoraphobia (PDA) was compared with both waiting list and credible attention-placebo control groups. EMDR was significantly better than waiting list for some outcome measures (questionnaire, diary, and interview measures of severity of anxiety, panic disorder, and agoraphobia) but not for others (panic attack frequency and anxious cognitions). However, low power and, for panic frequency, floor effects may account for these negative results. Differences between EMDR and the attention-placebo control condition were not statistically significant on any measure, and, in this case, the effect sizes were generally small (eta2 = .00-.06), suggesting the poor results for EMDR were not due to lack of power. Because there are established effective treatments such as cognitive-behavior therapy for PDA, these data, unless contradicted by future research, indicate EMDR should not be the first-line treatment for this disorder.

Adult↗

PubMed1999

Inflated perceptions of responsibility and obsessive-compulsive symptoms.

In Salkovskis' [Salkovskis, P. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 28, 571-588; Salkovskis P. (1989) Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy, 27, 677-682] cognitive model for obsessive-compulsive disorder (OCD), inflated perception of responsibility is highlighted as the critical feature that maintains the disorder. In the current study, the relationship between responsibility and obsessive-compulsive (OC) symptoms was examined. Specifically, three measures of responsibility were evaluated for their psychometric properties. These measures were then used to test Salkovskis's model by examining the relationships among pervasive responsibility, automatic thoughts related to causing harm, and OC symptom severity. Findings provide partial support for the validity and reliability of the measures and for the model as a whole. Based on regression analyses, data support that pervasive responsibility significantly contributes to the prediction of OC symptoms. Furthermore, this relationship appears to be mediated by automatic thoughts related to causing harm in OCD contexts.

Adult↗

PubMed1999

Expressed emotion and behavior therapy outcome: a prospective study with obsessive-compulsive and agoraphobic outpatients.

The relationship of expressed emotion (EE) to behavior therapy outcome for obsessive-compulsive disorder (n = 60) and panic disorder with agoraphobia (n = 41) was investigated. Relatives' emotional overinvolvement and hostility predicted higher rates of treatment dropout. Higher hostility, as assessed by the Camberwell Family Interview (CFI), was related to poorer outcome for target ratings and for the Social Adjustment Scale; higher perceived criticism was also predictive of worse response on target ratings. In contrast, nonhostile criticism on the CFI was associated with better outcome on the behavioral avoidance test. In general, the relationship of EE to outcome was not moderated by type of relative, diagnosis, amount of contact with the relative, or use of psychotropic medication.

Adult↗

PubMed1998

Behavioral treatment of obsessive-compulsive disorder in African Americans: clinical issues.

African Americans with obessive-compulsive disorder are underrepresented in behavioral treatment outcome studies. This paper consists of a clinical discussion of issues arising during the treatment with exposure plus response prevention of two African-American women with obessive-compulsive disorder. Clinical issues, such as excessive shame, insanity fears, and a sense of uniqueness, complicated the treatment process. However, both clients made significant improvement as assessed by behavioral testing, target ratings and the Yale-Brown Obsessive-Compulsive Scale.

Adult↗

PubMed1998

Are emotions frightening? II: An analogue study of fear of emotion, interpersonal conflict, and panic onset.

Two studies with college students were conducted to further explore the reliability and construct validity of fear of emotion, as assessed by the Affective Control Scale (ACS), a measure of fear of anxiety, depressed mood, anger, and strong positive emotion. The ACS fared well in tests of internal consistency and of convergent and divergent validity. In an analogue study of panic onset with college students with no history of panic, the predictive and incremental validity of the ACS was demonstrated: the ACS predicted students' fear of induced panic-like bodily sensations even once trait and state anxiety were statistically controlled. A second aspect of the investigation was an analogue test of the hypothesis that stress from interpersonal conflict (induced via remembrance of conflictual interactions with an important person) would moderate the ACS's effects on anxiety and fear of induced bodily sensations. This hypothesis was not confirmed.

Adolescent↗

PubMed1998

Behavioral assessment of social performance: a rating system for social phobia.

The Social Performance Rating Scale (SPRS) is a modification of the rating system for behavioral assessment of social skills, originally developed by Trower, P., Bryant, B., & Argyle, M. (1978). Social skills and mental health. Pittsburgh: University of Pittsburgh Press) and subsequently adapted by Turner and colleagues (e.g., Turner, S.M., Beidel, D.C., Dancu, C.V., & Keys, D.J. (1986). Psychopathology of social phobia and comparison to avoidant personality disorder. Journal of Abnormal Psychology, 95, 389-394). Designed to yield ratings of social performance appropriate for use in a socially phobic population and based on videotaped role plays, the five SPRS ratings are gaze, vocal quality, speech length, discomfort, and conversation flow. The sum of these ratings provides an internally consistent total score. In an initial study of the psychometric properties of the SPRS, three groups were assessed: individuals with social phobia, another anxiety disorder, or no psychological disorder. Inter-rater reliability for individual items and the total score proved excellent, and positive evidence for convergent, divergent, and criterion-related validity was obtained.

Adult↗

PubMed1998

Defining empirically supported therapies.

A scheme is proposed for determining when a psychological treatment for a specific problem or disorder may be considered to be established in efficacy or to be possibly efficacious. The importance of independent replication before a treatment is established in efficacy is emphasized, and a number of factors are elaborated that should be weighed in evaluating whether studies supporting a treatment's efficacy are sound. It is suggested that, in evaluating the benefits of a given treatment, the greatest weight should be given to efficacy trials but that these trials should be followed by research on effectiveness in clinical settings and with various populations and by cost-effectiveness research.

Cost-Benefit Analysis↗

PubMed1998

Validity of the Perceived Criticism Measure in an undergraduate sample.

The concurrent and predictive validity of the Perceived Criticism Measure's Criticism and Upset subscales was assessed for undergraduates, 21 men and 98 women. Participants were asked to identify five people important to them at present (typically these were parents as well as peers) and, for each, to rate how critical that person was as well as how upsetting they found that criticism to be. Scores on Upset exhibited convergent validity with another self-report measure of general sensitivity to criticism, whereas those on Criticism did not. Neither measure predicted higher ratings of criticism in a specific interaction with a mildly critical peer. Divergent validity with scores on a measure of depression was supported for Upset but was less clear for Criticism. Strong evidence of predictive validity for Criticism and Upset was obtained. Ratings for both Peer scales predicted increased negative affect after mild criticism from a peer, although this interaction took place 4 to 10 weeks after administration of the Perceived Criticism Measure.

Adolescent↗

PubMed1997

Measurement of panic disorder by a modified panic diary.

The psychometric characteristics of panic diary measures were investigated in a sample of 37 patients suffering from panic disorder with agoraphobia. Following recommendations made in the recent consensus development conference on the assessment of panic disorder, daily ratings included not only the occurrence of panic attacks but also fear of panic, expectancy of panic, and expected aversiveness of panic. These new measures were reliable and, on the whole, demonstrated good divergent and convergent validity. Further, adding such measures increased the incremental validity of panic disorder assessment.

Adult↗

PubMed1997

Convergent and divergent validity of the Beck Anxiety Inventory for patients with panic disorder and agoraphobia.

Psychometric properties of the Beck Anxiety Inventory (BAI) (Beck and Steer, 1990) were investigated in a sample of 82 patients suffering from panic disorder with agoraphobia. Before and after brief treatment, patients completed a battery of questionnaires and, for 2-week periods, kept a daily panic diary in which they recorded panic attacks, fear of panic, and average anxiety. The BAI demonstrated excellent internal consistency and good test-retest reliability over a 5-week interval. A partial multitrait, multimethod correlation matrix provided evidence of convergent validity with other measures of anxiety and of divergent validity vis á vis measures of depression. Factor analyses of pretest scores and residual gain scores used to address criticism that the BAI is excessively panic-centric yielded mixed results. In one analysis, the BAI was loaded with multimethod measures of panic and anxiety and, in the other, with questionnaire methods of assessing anxiety and depression. However, the BAI was clearly distinguished from measures of fear of fear, a central construct in panic disorder, and agoraphobic avoidance. Finally, the BAI proved sensitive to change with treatment, yielding effect sizes for improvement comparable to those of other anxiety measures.

Adult↗

PubMed1997

Self-focused attention in the treatment of social phobia.

For those with social phobia self-focused attention has been linked with impairment in social performance increased social anxiety, and a higher frequency of self-critical thoughts during social situations. The purpose of this investigation was to assess correlates of changes in situational self-focus over the course of cognitive-behavioral treatment (CBT). Focus of attention was assessed after in-session role-plays and after in vivo homework assignments during group CBT for social phobia. Analyses revealed a significant decrease in self-focused attention over time; focus on events and stimuli outside of the self remained unchanged. Treatment gains on anxiety during dyadic interactions, on negative self-judgments, and on personalized social fears were related to reduction in self-focused attention. Those with public speaking phobias showed a strong relationship between decreased self-focus and speech anxiety. These findings suggest that changes in self-focused attention during the course of CBT are related to important therapeutic gains Specific interventions aimed at decreasing self-focus may be a useful treatment strategy.

Adult↗

PubMed1997

Are emotions frightening? An extension of the fear of fear construct.

Proposed in this paper is an expansion of the concept of fear of fear to include fear of other emotions (anger, depression, and positive emotions). In Study 1, initial evidence of the reliability and validity of a questionnaire designed to measure this construct, the Affective Control Scale, is provided. In Study 2, an analogue experiment of susceptibility to panic disorder was conducted. The ability of fear of anger, depression, and positive emotions to predict fear of laboratory-induced bodily sensations in a population with no history of panic attacks was demonstrated.

Adult↗

PubMed1996

Behavioral avoidance test for obsessive compulsive disorder.

Few treatment outcome studies of Obsessive Compulsive Disorder (OCD) have employed Behavioral Avoidance Tests (BATs) to assess changes in symptomatology, probably because of the difficulty of constructing such tests for a disorder which has widely varying symptoms. The few studies that have examined the psychometric properties of BATs for OCD have found mixed evidence for validity but good treatment sensitivity. The present study presents psychometric findings for a multi-step/multi-task BAT that assessed percentage of steps completed, subjective anxiety, global avoidance, and rituals. This measure was used with 50 clients diagnosed with OCD whose symptoms varied widely. The BAT demonstrated good convergent and divergent validity, as well as treatment sensitivity according to effect size calculations. A composite score combining steps, anxiety level, avoidance and rituals also performed well in psychometric tests. Strategies to reduce the complexity of scoring are presented, along with examples of several BAT tasks to enable researchers to employ this behavioral measure.

Adolescent↗