Automatic and effortful processes were investigated using event-related brain potentials (ERPs) recorded from moderately impaired subjects with probable Alzheimer's Disease (AD), normal elderly, and normal young controls. The effects of effortful attention on ERPs to loud noises and the effects of stimulus intrusiveness on effortfully elicited ERPs were studied. First, ERPs to task relevant and irrelevant startling noises were compared. Second, ERPs to startling noises and moderate tones were compared when both were targets. The effects of age (young vs. elderly controls) and effects of dementing disease (AD subjects vs. elderly controls) were also assessed. Effortful attention augmented noise-elicited P300 amplitude in elderly subjects, but not in young. Intrusiveness augmented task-relevant P300 amplitude in young subjects, but not in elderly. Neither variable affected P300 amplitude in AD subjects. Thus, effects of age and disease depended on how P300 was elicited: when effortfully elicited, P300 amplitude was affected by disease but not age; when automatically elicited, P300 amplitude was affected by age but not disease. N1 effects differed from P300 effects.

Acoustic Stimulation↗

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The somatic symptom paradox in DSM-IV anxiety disorders: suggestions for a clinical focus in psychophysiology.

Although DSM-IV criteria for anxiety disorders include physiological symptoms, these symptoms are evaluated exclusively by verbal report. The current review explores the background for this paradox and tries to demonstrate on theoretical and empirical grounds how it could be resolved, providing new insights about the role of psychophysiological measures in the clinic. The three-systems approach to evaluating anxiety argues that somatic measures as well as verbal and behavioral ones are indispensable. However, the low concordance between these domains of measurement impugns their reliability and validity. We argue that concordance can be improved by examining the relationship of variables less global than anxiety and by restriction to specific anxiety disorders. For example, recent evidence from our and other laboratories indicate a prominent role of self-reported and physiologically measured breathing irregularities in panic disorder. Nonetheless, even within a diagnosis, anxiety patients vary radically in which somatic variables are deviant. Thus, in clinical practice, individual profiles of psychological and physiological anxiety responses may be essential to indicate distinct therapeutic approaches and ways of tracking improvement. Laboratory provocations specific to certain anxiety disorders and advances in ambulatory monitoring vastly expand the scope of self-report and physiological measurement and will likely contribute to a refined assessment of anxiety disorders.

Anxiety Disorders↗

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The emotional Stroop effect in anxiety disorders: general emotional or disorder specificity?

Selective attentional biases, often documented with a modified Stroop task, are considered to play an important role in the etiology and maintenance of anxiety. Two competing explanations for these effects are selectivity for highly emotional words in general vs. selectivity for disorder-specific words. We tested these explanations in 32 patients with generalized anxiety disorder (GAD), 29 patients with social phobia (SP), and 31 non-anxious controls. Stimuli were of four kinds: GAD-related words, SP-related words, words with a neutral valence, and words with a positive valence. Different attentional biases were observed: GAD patients were slowed by all types of emotional words, while SP patients were distracted specifically by speech-related words.

Adult↗

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Clinical characteristics of flight phobia.

Sixty-six subjects with severe fear of flying were recruited by advertisement and compared to 21 controls without flying fears. Subjects were interviewed and given several questionnaires to determine DSM-III-R diagnoses, history of flying, and development and course of flying phobia. Our phobic sample had a mean age of 46 and was 89% female. Diagnostically, 27% met criteria for current Panic Disorder with Agoraphobia, and 17% criteria for that diagnosis in the past. These two groups were more concerned with internal or social anxiety stimuli during flight than the group who had never had panic attacks but met criteria for Simple Phobia (flying). All three groups were equally concerned about external dangers. Traumatic flight events were common in phobics and controls, but phobics reported reacting to these events more strongly. Our results suggest a vulnerability-stress model with several vulnerability factors, including cognitive ones. Treatment implications are discussed.

Agoraphobia↗

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Speech disturbances and gaze behavior during public speaking in subtypes of social phobia.

Twenty-four social phobics with public speaking anxiety and 25 nonphobic individuals (controls) gave a speech in front of two people. Subjective anxiety, gaze behavior, and speech disturbances were assessed. Based on subjects' fear ratings of social situations, phobics and controls were divided into the generalized and nongeneralized subtype. Results showed that generalized phobics reported the most, and nongeneralized controls the least anxiety during public speaking. All subjects had longer and more frequent eye contact when delivering a speech than when talking with an experimenter or sitting in front of an audience. Phobics showed more filled pauses, had longer silent pauses, paused more frequently, and spent more time pausing than controls when giving a speech. Generalized phobics spent more time pausing during their speech than the other subgroups (nongeneralized controls, generalized controls, and nongeneralized phobics). These results suggest that generalized phobics tended to shift attentional resources from speech production to other cognitive tasks.

Adult↗

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Don't worry and beware of white bears: thought suppression in anxiety patients.

The ability to suppress unwanted thoughts was investigated in patients with Generalized Anxiety Disorder (GAD; n = 29), Speech Phobics (n = 25), and nonanxious controls (n = 28). All participants spent 5 minutes thinking aloud about anything that came to mind while trying not to think of white bears. In another task, they thought aloud for 5 minutes while trying not to think of their main worry. Intrusions of unwanted thoughts were signaled by button presses and recorded on tape. In accordance with the disorder's definition and complaints of the GAD patients, they showed more intrusions of their main worry than of white bears. The opposite was true for other participants. Compared to a baseline measure, all participant groups were unable to reduce duration of main worry thoughts when trying to suppress them.

Adult↗

PubMedDate not supplied

Sodium lactate infusions and panic attacks: a review and critique.

Response to sodium lactate infusions has been proposed as an experimental model and a biologic marker for panic attacks. Several authors have claimed that patients suffering from panic attacks, but not normal controls, "panic" in response to lactate. A careful review of methods and results of 13 studies, however, reveals serious methodologic problems, lack of specificity and sensitivity, and a failure to consider cognitive variables. When baseline differences are ruled out, the responses of patients and controls may not differ. So far, response to lactate cannot be interpreted as a model and marker for panic attacks and does not provide evidence for their underlying biologic distinctness from other types of anxiety. Known biologic mechanisms do not sufficiently explain the effects of lactate. Instead, an interaction of peripheral physiologic changes, past experience, environmental cues, and their appraisal as threatening or dangerous seems to be a more appropriate model.

Anxiety Disorders↗

PubMedDate not supplied

Mitral valve prolapse and panic disorder: a review of their relationship.

There has been considerable speculation about a possible relationship between panic disorder and mitral valve prolapse syndrome (MVP), although empirical results have been highly inconsistent. Some studies report low frequencies of 0-8%, others high frequencies of 24-35% "definite" MVP in panic patients (average across 17 studies: 18% of panic patients, 1% of normal controls). Elevated prevalences of MVP were also reported for generalized anxiety disorder, bipolar affective disorder, and anorexia nervosa. Studies of MVP patients generally failed to find elevated prevalence of panic compared to other cardiac patients or normal controls (averages across seven studies: 14%, 10%, and 8%, respectively). Inconsistent results may be due to widely different diagnostic criteria for MVP, low reliability of this diagnosis, inadequate control groups, "non-blind" ratings of panic or MVP, and sampling bias in both patient and control populations. These problems as well as the great variations in the published results preclude any final judgment. If there is concomitance between MVP and panic, it is small and primarily involves subjects with milder or reversible variants of MVP. At present it seems most justified, however, to assume co-morbidity in highly symptomatic individuals rather than a functional relationship.

Fear↗

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Voluntary breath holding in panic and generalized anxiety disorders.

OBJECTIVE: Because breath holding causes arterial pCO2 to increase, we used it to test the hypothesis that in panic disorder (PD) a biological suffocation monitor is pathologically sensitive. METHOD: Nineteen patients with PD, 17 with generalized anxiety disorder (GAD), and 22 normal controls took deep breaths on signal and held them until a release signal was given 30 seconds later. This was repeated 12 times separated by 60-second normal breathing periods. RESULTS: PD patients reported having had in the past more symptoms of shortness of breath when anxious, and more frequent frightening suffocation experiences than the other groups. However, increases in self-rated anxiety between periods of normal breathing and periods of breath holding were similar in all three groups. Skin conductance, blood pressure, and T-wave amplitude reactions to breath holdings were also similar, but heart rate acceleration upon taking a deep breath was greater in GAD patients. Before and after individual breath holdings, end-tidal pCO2 was lower in PD patients than in normal controls; GAD patients were intermediate. Inspiratory flow rate did not differ between groups. CONCLUSIONS: Our physiological results provide no direct support for an overly sensitive suffocation alarm system in PD. Lower pCO2 may be due to anxiety causing hyperventilation in patients prone to panic.

Adult↗

PubMedDate not supplied

Slow recovery from voluntary hyperventilation in panic disorder.

OBJECTIVE: Because hyperventilation has figured prominently in theories of panic disorder (PD) but not of social phobia (SP), we compared predictions regarding diagnosis-specific differences in psychological and physiological measures before, during, and after voluntary hyperventilation. METHOD: Physiological responses were recorded in 14 patients with PD, 24 patients with SP, and 24 controls during six cycles of 1-minute of fast breathing alternating with 1 minute of recovery, followed by 3 minutes of fast breathing and 10 minutes of recovery. Speed of fast breathing was paced by a tone modulated at 18 cycles/minute, and depth by feedback aimed at achieving an end-tidal pCO2 of 20 mm Hg. These values were reached equally by all groups. RESULTS: During fast breathing, PD and SP patients reported more anxiety than controls, and their feelings of dyspnea and suffocation increased more from baseline. Skin conductance declined more slowly in PD over the six 1-minute fast breathing periods. At the end of the final 10-minute recovery, PD patients reported more awareness of breathing, dyspnea, and fear of being short of breath, and their pCO2s, heart rates, and skin conductance levels had returned less toward normal levels than in other groups. Their lower pCO2s were associated with a higher frequency of sigh breaths. CONCLUSIONS: PD and SP patients report more distress than controls to equal amounts of hypocapnia, but PD differ from SP patients and controls in having slower symptomatic and physiological recovery. This finding was not specifically predicted by hyperventilation, cognitive-behavioral, or suffocation alarm theories of PD.

Adult↗