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Biomedical subjects

M G Craske

Publications and source records attributed to M G Craske.

At least 55 records · Page 3Linked to original sources
PubMed1992

Animal phobias versus claustrophobias: exteroceptive versus interoceptive cues.

The overall purpose of this investigation was to examine heterogeneity among specific phobias. In particular, the goals were to compare features of fear responding between individuals fearful of claustrophobic situations and individuals fearful of spiders/snakes, and to compare their response to hyperventilation challenges. By so doing, specific predictions were tested in relation to a conceptual model of exteroceptive and interoceptive fear cues. Using a nonclinical sample, 19 subjects with spider/snake phobias, 18 nonphobics, and 9 subjects with claustrophobias were exposed on two separate occasions to a live tarantula or python, a small closet, and a hyperventilation challenge. Dependent measures included subjective anxiety, panic attacks, physical symptoms, cognitive symptoms (or, fear of symptoms) and heart rate. In addition, subjects completed a standardized self-report scale that measures fear of bodily symptoms of arousal. It was found that subjects with claustrophobia reported more physical symptoms and cognitive symptoms than did subjects with snake/spider phobias, in response to their fear-relevant stimulus. In addition, claustrophobic subjects were more fearful of hyperventilation challenges and reported more fear of bodily symptoms, than did snake/spider phobic subjects. Finally, subjects with claustrophobia were as fearful of hyperventilation as they were of their fear-relevant stimulus. Theoretical and empirical implications of these findings are discussed.

Adult↗
PubMed1990

Situational exposure treatment versus panic control treatment for agoraphobia. A case study.

Situational in vivo exposure has been widely used in the treatment of agoraphobia. However, only a low to moderate proportion of individuals treated with this approach have shown a high level of therapeutic gain. The recent recognition of panic as central to the development and maintenance of a great many cases of agoraphobic avoidance suggests that treatments focused directly on panic may contribute to a more comprehensive approach to agoraphobia. The present single case demonstrates that whereas two modes of situational exposure produced only limited improvement an approach focused directly on panic had greater effectiveness. The specific effects of the treatment components within the panic control package are analyzed in detail.

Adaptation, Psychological↗
PubMed1990

A descriptive report of features of initial unexpected panic attacks in minimal and extensive avoiders.

Interview data from 162 subjects assigned a diagnosis of panic disorder with or without agoraphobia were analyzed regarding descriptive features of initial panic attacks. The extent to which groups of minimal and extensive avoiders were differentiated by such features was examined. Overall, initial panic attacks were likely to occur at any time of year, and were associated with reported stressors in 72% of the cases. The most frequently reported stressors were somatic in nature. Approximately half of the subjects reported experiencing similar although milder experiences prior to the first panic attack. No differences were found between minimal and extensive avoiders in terms of the presence of others, behavioral response, or location of the first panic attack. Nor did the groups differ with respect to the presence of other anxiety disorders prior to the first panic. However, extensive avoiders tended subsequently to develop additional anxiety disorders moreso than minimal avoiders. Initial panic attack locations were also judged to be more capable of blocking escape action tendencies associated with the fear/panic response in the extensive avoidance group.

Adult↗
PubMed1990

Nocturnal panic: response to hyperventilation and carbon dioxide challenges.

To examine the role of ventilatory response in nocturnal panic, subjects experiencing nocturnal panic were compared with those who experienced daytime panic attacks only. In particular, measures of chronic hyperventilation (baseline pCO2) and CO2 hypersensitivity (response to ventilatory challenges) were assessed. Subjective and psychophysiological measures were obtained during baseline, forced hyperventilation, and carbon dioxide inhalation phases of a standardized laboratory-based assessment. The groups did not differ with respect to subjective or physiological measures or to the frequency with which panic occurred during the assessment. The results do not lend support to models that emphasize central CO2 hypersensitivity and chronic hyperventilation as primary mechanisms underlying nocturnal panic.

Acid-Base Equilibrium↗
PubMed1989

'Fear of panic': an investigation of its role in panic occurrence, phobic avoidance, and treatment outcome.

The concept of 'fear of fear' has recently received empirical attention regarding its role in panic occurrence and phobic avoidance. Overall, the results of such studies have indicated that anticipation of panic is positively correlated (albeit weakly) with self-reports of avoidance. The present study examined the relationship of panic anticipation--panic occurrence, phobic avoidance and treatment outcome, using a more direct measure of this fear than has been used in previous studies. Results indicated that anticipation of panic was slightly correlated with breadth and severity of avoidance, and moderately correlated with overall clinical severity. In addition, anticipation of panic was found to decrease significantly throughout treatment, but appeared to be independent of actual panic experience. These results may suggest the operation of an intervening variable which accounts for the reduction of both anticipated and actual panic events. Implications for assessment and treatment are discussed.

Adolescent↗
PubMed1989

Qualitative dimensions of worry in DSM-III-R generalized anxiety disorder subjects and nonanxious controls.

Revisions to DSM-III cite apprehensive expectation or 'worry' as a defining feature of generalized anxiety disorder (GAD). The quality and focus of worry reported by groups of GAD patients (n = 19), and nonanxious 'controls' (n = 26) were examined using self-monitored data. Content categorizations by independent raters showed that GAD patients worried more about illness, health and injury issues and displayed a tendency to worry more about miscellaneous 'minor' issues. These descriptor ratings differentiated the worries of GAD patients from those of non-anxious controls: perceived control over worrying, the extent to which the worry was considered realistic, and perceived success with which worry was alleviated using corrective/preventative actions. The data are related to the DSM-III-R criteria for GAD and to conceptualizations of the nature of excessive worry.

Adult↗
PubMed1989

Relationships among measures of communication, marital satisfaction and exposure during couples treatment of agoraphobia.

The goals of this study were to examine the relationships among measures of couples interactions (satisfaction and communication), and response to treatment within a group of agoraphobic clients and their partners. The treatment included the clients' partners in structured, graduated in vivo exposure practices. Twenty-two clients and their partners completed pre-, mid- and post-treatment assessments. Treatment responders rated themselves and their partners as more communicative regarding the client's fears, at pre- and mid-assessments in comparison to nonresponders; measures of communication related inversely to levels of anxiety reported during exposures, but marital satisfaction did not relate to any measure of exposure. In addition, level of anxiety during exposure differentiated responders from nonresponders; responders experienced a significant reduction in their levels of anxiety. Finally, ratings of frequency of communication at mid-assessment were highly predictive of treatment outcome at post-assessment. The implications from these findings for communication skills training for a subset of couples who enter couples treatment for agoraphobia are discussed.

Adult↗
PubMed1989

Sensations, cognitions and the perception of cues associated with expected and unexpected panic attacks.

Panic attacks may be perceived by patients as either cued or uncued (spontaneous) and either expected or unexpected. The purpose of the present study was to examine the prevalence and characteristics of these types of panic. Twenty-six panic disorder patients with mild avoidance and 18 with moderate or severe avoidance were instructed to complete a questionnaire during or immediately following each of three consecutive naturally occurring panic attacks they experienced. They were asked to rate the extent to which they expected the panic attack to occur, whether they felt it was associated with an external panic "cue" (e.g. a shopping mall), whether they would expect to panic again in similar circumstances, their mood, present level of life stress, and fear and severity of their body sensations and disturbing cognitions. Results indicated that from a sample of 92 questionnaires, each representing a separate panic, nearly 70% of panic attacks were rated as cued-expected and only one panic was rated as uncued-expected. The other two categories each comprised about 15% of all panic attacks. There were few reported differences in body sensations and cognitions reported as a function of type of panic and no differences with regard to extent of agoraphobic avoidance. Expected panic was associated with a higher expectation of future panic in similar circumstances.

Adult↗
PubMed1989

Instructions to focus upon or distract from internal cues during exposure treatment of agoraphobic avoidance.

Instructions to focus upon feared somatic sensations were compared to instructions to engage in distracting tasks, while practising in vivo exposure to feared agoraphobic situations. Thirty individuals assigned a primary diagnosis of Panic Disorder with moderate to severe Agoraphobia were assigned randomly to one of the two treatment conditions. Assessments were conducted pre, post and 6 months following treatment completion, using subjective, behavioral and clinician-rated measures of change. Composite outcome criteria indicated a trend for distracted exposure to yield a higher percentage of improvement than focused exposure, at post assessment. However, focused exposure group members improved to a greater extent over the follow-up interval than members of the distracted group. These trends were relatively weak, given the absence of significant group by time interactions in terms of individual variable analyses. The results were discussed with reference to the role of distraction in fear reduction.

Adolescent↗
PubMed1989

Nocturnal panic.

The phenomenon of nocturnal panic was examined by comparing individuals with panic disorder who reported the experience of nocturnal panic (N = 37) with those who did not (N = 56). Variables that were assessed included frequency and intensity of daytime panic attacks, generalized anxiety, and responses to a standardized physiological assessment. In addition, the most recent nocturnal panic was rated on measures of intensity, duration, and circumstances. Nocturnal panic occurred in individuals who were equally avoidant and distressed as individuals who did not experience nocturnal panic. However, nocturnal panickers experienced daytime panics and general somatic sensations more frequently than other panickers. The similarity of nocturnal panic to sleep apnea, dream-induced anxiety attacks, and night terrors is discussed. The nature of nocturnal panic is described within the context of an explanatory model that combines behavioral and physical factors.

Adult↗
PubMed1987

Return of fear: perceived skill and heart-rate responsivity.

The hypothesis that high heart rate and low perceived skill would be associated with greater return of fear than low heart rate and high perceived skill was investigated in a group of 63 anxious musical performers. Musicians were taught progressive muscle relaxation and attention-focusing skills over the course of four weekly sessions. Return of subjective fear was assessed between training programme sessions and at a three-month follow-up assessment. Performance quality ratings served as the behavioural measure, anticipatory heart rate as the physiological measure, and subjective units of distress scales as the subjective measure. Four classification groups (high heart rate, low perceived skill; high heart rate, high perceived skill; low heart rate, low perceived skill; and low heart rate, high perceived skill) were formed on the basis of median splits of heart rate and perceived skill pre-assessment levels. Each group demonstrated subjective fear reduction, while heart rate reduced in the high heart-rate subjects, and performance quality improved overall at post-assessment. Follow-up return of fear was apparent in high heart-rate subjects, regardless of their perceived skill status. High heart-rate subjects reported more anxious thoughts than did low heart-rate subjects. Perceived skill was not clearly associated with return of fear. Post-hoc comparisons indicated that subjects who demonstrated follow-up return of fear had higher heart rate, lower perceived skill, more anxious thoughts, less performance skill and fewer performances over the follow-up interval than subjects who did not demonstrate a return of fear. However, initial heart rate was the only significant predictor of follow-up fear levels.

Adolescent↗
PubMedDate not supplied

Assessment instrument for panic disorder that includes fear of sensation-producing activities: the Albany Panic and Phobia Questionnaire.

A set of items was developed to assess fear of activities which produce physical sensations (e.g., exercise) based on clinical observations that individuals with panic disorder fear such activities in addition to agoraphobic situations. Factor analysis of a 32-item pool based on responses from 438 subjects confirmed three distinct factors which were labelled: agoraphobia, social phobia, and interoceptive fears. Evidence was obtained to support the internal consistency, test-retest reliability, and construct validity of all three factors. Importantly, the interoceptive factor demonstrated a slightly different pattern of relationships with other constructs to the agoraphobic factor, even though the two were highly related. The present questionnaire will help to expand current assessments of panic disorder for both clinical work and research.

Adolescent↗
PubMedDate not supplied

Stability of catastrophic cognitions in panic disorder.

This study examined the degree to which panic disorder patients recognized the irrationality of their fearful cognitions during the midst of panic and at other times, when not panicking. Also, the degree to which panic-cognitions changed over time was examined. Approximately 40% retained at least moderately strong conviction in their panic-cognitions when not panicking. Females and non-medicated patients held stronger convictions. Fearful cognitions about physical dangers were more likely to decrease over time than fearful cognitions about mental or social dangers.

Agoraphobia↗
PubMedDate not supplied

Effects of an expanding-spaced vs massed exposure schedule on fear reduction and return of fear.

The current investigation assessed the relative benefits of a massed vs an expanding-spaced exposure schedule. The study was a 2 (distribution of sessions) x 3 (assessment occasion) design, in which two spider-fearful groups (N = 31) were compared across three different occasions: pre-training, post-training, and follow-up. Four exposure trials were conducted within the same day for participants in the massed exposure (ME) group, whereas sessions were distributed over the course of 1 week (inter-trial intervals doubled between sessions) for the expanding-spaced exposure (ESE) group. As predicted, although the ME group demonstrated significantly more habituation than the ESE group across exposure trials, they also showed a clear return of fear (ROF) in response to the training spider at a 1-month follow-up assessment, whereas the ESE group showed no increase in fear. Additionally, the ME group showed ROF in response to novel spiders post-training and at the 1-month follow-up, whereas ESE participants did not. These findings offer support for the beneficial effects of an expanding-spaced schedule and challenge the reliance on indices of fear activation and habituation as accurate signals of the permanence of fear reduction.

Adult↗
PubMedDate not supplied

Effects of varied-stimulus exposure training on fear reduction and return of fear.

The current investigation assessed the relative treatment benefits of persistence with one specific stimulus vs exposure to multiple versions of a stimulus. The study was a 2 (type of stimulus) x 3 (assessment occasion) design, in which two spider-fearful groups (N = 28) were compared across three different occasions: pre-treatment, post-treatment, and follow-up. Exposure trials were conducted with the same tarantula for participants in the control group, whereas experimental participants were exposed to four novel tarantulas. As predicted, the control group demonstrated significantly more habituation than the experimental group across exposure trials, yet showed a clear return of fear in response to a control spider at a 3-week follow-up assessment whereas the experimental group showed no increase in fear. These findings offer support for the beneficial effects of varying the stimulus during exposure, and challenge the reliance on indices of fear activation and habituation as accurate signals of the permanence of fear reduction.

Adult↗