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Biomedical subjects

M G Craske

Publications and source records attributed to M G Craske.

At least 37 records · Page 2Linked to original sources
PubMed1999

Interoceptive accuracy and panic.

Psychophysiological models of panic hypothesize that panickers focus attention on and become anxious about the physical sensations associated with panic. Attention on internal somatic cues has been labeled interoception. The present study examined the role of physiological arousal and subjective anxiety on interoceptive accuracy. Infrequent panickers and nonanxious participants participated in an initial baseline to examine overall interoceptive accuracy. Next, participants ingested caffeine, about which they received either safety or no safety information. Using a mental heartbeat tracking paradigm, participants' count of their heartbeats during specific time intervals were coded based on polygraph measures. Infrequent panickers were more accurate in the perception of their heartbeats than nonanxious participants. Changes in physiological arousal were not associated with increased accuracy on the heartbeat perception task. However, higher levels of self-reported anxiety were associated with superior performance.

Adult↗
PubMed1999

Alteration of memory in the reduction of children's distress during repeated aversive medical procedures.

The present study sought to reduce children's distress during aversive medical procedures using a brief, cost-effective intervention aimed at reframing memory. Fifty children diagnosed with leukemia (25 treatment, 25 attention control, aged 3-18) were observed as they underwent 3 consecutive lumbar punctures (LPs; baseline, postintervention, and follow-up). Self-report, physiological, and observable distress measures were collected before and after each LP. At posttreatment, children in the intervention group showed reductions in anticipatory physiological and self-report ratings relative to the control group. At follow-up, these effects generalized to reductions in procedural distress. These results suggest that (a) a simple memory-based intervention is efficacious at reducing children's distress and (b) benefits from this intervention are maintained over 1 week even without continued intervention.

Adaptation, Psychological↗
PubMed1999

Panic disorder in the primary care setting: comorbidity, disability, service utilization, and treatment.

BACKGROUND: Increased medical service utilization in patients with panic disorder has been described in epidemiologic studies, although service use in primary care panic patients relative to other primary care patients is less well characterized. Inadequate recognition of panic has been shown in several primary care studies, although the nature of usual care for panic in this setting has not been well documented. This study aimed to document increased service use in panic patients relative to other primary care patients and to characterize the nature of their usual care for panic and their outcome. METHOD: Using a waiting room screening questionnaire and follow-up telephone interview with the Composite International Diagnostic Interview, we identified a convenience sample of 81 patients with panic disorder (DSM-IV) and a control group of 183 psychiatrically healthy patients in 3 primary care settings on the West Coast and determined psychiatric diagnostic comorbidity, panic characteristics, disability, and medical and mental health service use, including medications. A subsample (N = 41) of panic patients was reinterviewed 4-10 months later to determine the persistence of panic and the adequacy of intervening treatment received using the Harvard/Brown Anxiety Disorders Research Program study criteria for cognitive-behavioral therapy (CBT) and an algorithm developed by the authors for medications. RESULTS: Seventy percent of panic patients had a comorbid psychiatric diagnosis. Patients had more disability in the last month (days missed or cut down activities) (p < .01), more utilization of emergency room and medical provider visits (p < .01), and more mental health visits (p < .05). Despite the latter, only 42% received psychotropic medication, 36% psychotherapy, and 64% any treatment. On follow-up, 85% still met diagnostic criteria for panic, and only 22% had received adequate medication (type and/or dose) and 12% adequate (i.e., CBT) psychotherapy. CONCLUSION: These findings suggest a need for improved treatment interventions for panic disorder in the primary care setting to decrease disability and potentially inappropriate medical service utilization.

Adult↗
PubMed1997

Information processing in anxiety and depression.

Performance on explicit and implicit memory tasks was compared among non-clinical participants (N = 47) who reported low anxiety and low depression, high anxiety and low depression, or high anxiety and high depression. No differences were found among the groups in explicit memory. Differences in our measure of implicit memory were attributable to higher anxiety, regardless of depression. Increased implicit memory was specific to personally relevant information. The study highlights the need for further exploration of information processing in mixed anxiety and depression.

Analysis of Variance↗
PubMed1997

Interoceptive exposure versus breathing retraining within cognitive-behavioural therapy for panic disorder with agoraphobia.

This study compared two components of a cognitive-behavioural treatment for panic disorder. Thirty-eight individuals with panic disorder and agoraphobia were randomly assigned to (a) cognitive restructuring, interoceptive exposure (i.e. repeated exposure to feared bodily sensations) and in vivo exposure to agoraphobic situations; or (b) cognitive restructuring, breathing retraining and in vivo exposure to agoraphobic situations. Assessments were conducted at pre-treatment, post-treatment and six months later. The treatments were equally effective on many measures. However, treatment that included interoceptive exposure was more effective at post-treatment in terms of panic frequency, overall severity and functioning, and more effective at six-month follow-up in terms of panic frequency, phobic fears and general anxiety and functioning. Follow-up results were limited due to attrition.

Adolescent↗
PubMed1997

Fear and anxiety in children and adolescents.

The author reviews fears and anxiety in children and adolescents. In particular, the nature and prevalence of fears and anxiety disorders, including panic disorder, are described. This is followed by a description of comorbidity and gender differences, and the stability or chronicity of these disorders. Factors believed to contribute to the development of childhood fear and anxiety are outlined, and finally the treatments for these disorders are reviewed.

Adolescent↗
PubMed1996

An integrated treatment approach to panic disorder.

After a brief description of cognitive-behavioral approaches for the treatment of panic disorder, the advantages and disadvantages of an integrated approach that combines cognitive-behavioral methods and medications are presented. This is followed by presentation of outcome data regarding combined treatment, and of methods for enhancing the implementation of an integrated approach. Finally, directions for future research are listed. Other psychological treatments are not covered due to lack of evidence for their efficacy.

Antidepressive Agents, Tricyclic↗
PubMed1995

Brief cognitive-behavioral versus nondirective therapy for panic disorder.

Thirty panic disorder patients were assigned randomly to four weekly sessions of either cognitive-behavioral therapy or nondirective, supportive therapy. Dependent variables included clinician ratings, standardized self-report questionnaires, and self-monitoring. Cognitive-behavioral therapy led to significant reductions in worry about the recurrence of panic, and in overall ratings of phobic distress. Nondirective supportive therapy did not produce significant effects. In addition, proportionately more patients who were actively panicking at preassessment and underwent cognitive-behavioral treatment were free of panic after treatment. More than one third (38%) of patients who received cognitive-behavioral treatment were sufficiently improved that they withdrew from the pharmacological trial and/or did not meet criteria for panic disorder by the end of the four weeks.

Adult↗
PubMed1995

Treatment of claustrophobias and snake/spider phobias: fear of arousal and fear of context.

Forty-nine individuals with fears of snakes or spiders, and 21 individuals with claustrophobic fear were assigned randomly to two sessions of either in vivo exposure plus relaxation or in vivo exposure plus disconfirmation of misappraisals of bodily sensations. Behavioral, subjective and physiological assessments were conducted pre and post treatment, and 4 weeks later. As hypothesized, disconfirmation of misappraisals of bodily sensations benefited claustrophobic fear reduction, but had little effect on fears of snakes or spiders. However, differential treatment effects failed to generalize to nontargetted phobic situations, or generalize over time. In addition, the two treatments affected basic beliefs about arousal sensations equally.

Adolescent↗
PubMed1995

Predicted versus unpredicted panic attacks: acute versus general distress.

Acute and longer term effects of unpredicted and predicted panic attacks were examined in a sample of patients with panic disorder who self-monitored their panic attacks over a 2-week interval. The study assessed the degree to which experimental observations of the effects of predictability over aversive events are paralleled in the clinical phenomenon of panic. For patients who experienced predicted and unpredicted panics, daily ratings of anxiety and worry about panic increased the day following unpredicted panic attacks and decreased or stabilized the day following predicted panic attacks. These patterns were not replicated in patients who experienced only 1 type of panic; nor were these patterns influenced by the frequency with which panic attacks occurred. Acute distress indexes did not differ during predicted and unpredicted panics, although patients who experienced predicted panic attacks exhibited more pervasive agoraphobic avoidance. The findings are discussed in relation to the safety-signal theory of prediction and alternative conceptualizations.

Acute Disease↗
PubMed1995

Dimensions of dysfunctional attitudes as vulnerabilities to depressive symptoms.

Empirical tests of the diathesis-stress component of A. T. Beck's (1976; A. T. Beck, A. J. Rush, B. F. Shaw, & G. Emery, 1979) cognitive theory of depression have generally not yielded positive results. The resulting focus on conceptual and methodological concerns has diverted attention from the more fundamental issue of how validly vulnerability is measured. The present investigation uses the Dysfunctional Attitude Scale (DAS; A. N. Weissman, 1979; A. N. Weissman & Beck, 1978), the most commonly used measure of vulnerability in this area, but adopts a more in-depth approach by examining DAS factors in addition to the typical total score. This study involved a sample of undergraduates who had never before taken a college-level examination. The dimension of the DAS measured by the Perfectionistic Achievement factor had the strongest relationship to increased depressive symptoms in response to poorer-than-expected performance on the examination. Implications for future research in this area are discussed.

Adolescent↗
PubMed1995

Expectations about arousal and nocturnal panic.

Expectations about arousal were examined in relation to nocturnal panic (NP). Eighteen panic disorder patients suffering from NP attacks and 18 control individuals were assigned randomly to conditions in which they were informed that audio feedback signals reflected heightened arousal that was either (a) expected and harmless or (b) unexpected. Participants relaxed and slept for 45 to 60 min, followed by presentation of periodic audio feedback signals. Physiological recording was continuous while subjective measures were collected at completion of the signals phase. NP patients in the unexpected--no reassurance condition were significantly more anxious and symptomatic than their counterparts in the expected reassurance condition, whereas control individuals did not differ across the 2 conditions. Physiological and behavioral data were less consistent than subjective measures. The results are interpreted as supportive of a cognitive-behavioral model of NP.

Acoustic Stimulation↗
PubMed1994

Match-mismatch of fear, panic and performance.

The present study tested predictions derived from Rachman's match-mismatch theory of fear. Students (N = 117) displaying claustrophobic fear made predictions of fear, panic and performance prior to exposure to a claustrophobic chamber. Subjects were then classified into groups (i.e. matchers, overpredictors, underpredictors) based on the congruence between their anticipated phobic reactions and their actual reactions during exposure. The effects of match-mismatch status on predictions of fear, panic and performance on a subsequent exposure trial were examined. Results provided further evidence that phobic Ss are frequently inaccurate in predicting their phobic reactions during exposure. Consistent with previous findings, Ss who overpredicted fear, panic or performance tended to lower their predictions on a subsequent exposure trial, whereas Ss who underpredicted fear, panic or performance showed heightened predictions upon subsequent exposure. Contrary to previous findings, Ss were more likely to underpredict rather than overpredict their phobic reactions. Our findings are in accord with those of Rachman indicating that the magnitude of mismatch between predicted and actual fear/panic is more influential in determining subsequent predictions of fear/panic than it is in determining Ss' actual fear/panic. Moreover, this asymmetry was observed when the mismatch paradigm was applied to phobic behavior (i.e. tendency to escape).

Adolescent↗
PubMed1994

Definitions of panic attacks and panic disorder in the DSM-IV: implications for research.

The authors review various definitions of panic and recent conceptual and empirical evidence that led to the revised definitions of panic in the Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition (DSM-IV; American Psychiatric Association, 1994). The DSM-IV definitions of panic are more precise and more empirically based than those contained in the DSM-III-R, but are designed primarily for clinicians rather than researchers. Thus, it is possible that definitions of panic used in research under the DSM-IV system will encompass a heterogeneous mix of emotional phenomena. Recommendations on essential components of a conservative definition of panic are proposed for research purposes. Implications of this definition for limited symptom attacks and "non-fearful" panic are elaborated and related to final definitions of panic attacks and panic disorder in the DSM-IV.

Electromyography↗
PubMed1993

Cues for health-related imagery in analogue worriers: a brief report.

The role of specific cues for eliciting fearful imagery in a sample of analogue worriers was examined. Picture, script and audiotape disease-related cues were presented to 12 nonworriers and 13 analogue worriers who worried about health and disease. In general, the picture and audiotape cues were most anxiety provoking and elicited the most vivid imagery, respectively, although ratings were in the moderate range. Repeated trials of brief imagery had little effect on imagery ratings or estimates of risk for contracting the disease (i.e. worry statements) in the worry group. Disconfirmation of risk for contracting the diseases tended to lessen post-imagery anxiety but only after a series of imagery trials. On the other hand, disconfirming information lessened risk estimation overall. The findings are related to the conceptualization of worry and imagery proposed by Borkovec and Hu (Behaviour Research and Therapy, 28, 153-158 1990).

Adaptation, Psychological↗
PubMed1993

The effects of distraction during exposure to phobic stimuli.

Theoretical conceptualizations regarding the role of attentional focus during exposure-based treatments for fear and anxiety suggest that distraction interferes with the mechanisms required for fear reduction, typically by preventing emotional and/or cognitive processing of the phobic stimulus and response. The present discussion reviews the current literature and demonstrates the paucity of empirical evidence supporting such notions. Seemingly conflicting findings are integrated upon close examination of the various qualitative dimensions of the distracters employed. These characteristics, which differed substantially across studies, include the nature of the attentional demand posed by the distracter (e.g. cognitive vs sensory demand) as well as the distracter's affective quality (e.g. neutral vs relaxing). The effects of differing dimensions of distraction on fear reduction, in addition to interaction with aspects of the exposure situation, are discussed. The need for further investigation of the qualitative dimensions of distraction, including their operational specification, is recognized. Finally, recommendations for future research are made.

Attention↗