Advances in Behaviour Research and Therapy最新文献

Hyperventilation is probably the most frequently discussed correlate of panic attacks. Although some authors see it as the main or even unique cause of panic attacks, there have been numerous reviews with contradictory conclusions. Recent research, however, provides some more clarity. After a short overview of the characteristics of hyperventilation, the present article discusses (1) indirect measures of the overlap between panic and hyperventilation, (2) direct measures of hyperventilation at rest and during naturally occurring panic, (3) the influence of cognitive variables, and (4) the major theories attempting to explain the relationship between hyperventilation and panic. The results indicate a substantial overlap between panic and hyperventilation, but by far no one-to-one relationship and no chronic hyperventilation in panic patients if anticipatory anxiety is ruled out. In addition, cognitive studies firmly support the relevance of perceptive and associative processes. Theories that consider hyperventilation as a necessary or sufficient condition for panic attacks are clearly discarded by the imperfect relationship between the two phenomena. The central chemoreceptor sensitivity theory of panic is consistent with the physiologic effects of both hyperventilation and CO₂ inhalation but has to face inconsistent results on ventilatory characteristics of panic patients. Furthermore, it can neither explain the weak responses to hyperventilation or CO₂ in some panic patients nor the influence of cognitive variables. Only a psychophysiological theory that takes cognitive, conditioning and physiologic factors into account is consistent with the total body of research accumulated to date. According to this approach, hyperventilation is related to panic in two ways: First, it is one of many processes that can lead to the perception of bodily sensations which may trigger positive feedback loops between sensations and anxiety responses. Second, because of the circular nature of such feedback processes, hyperventilation can also be a response to anxiety. In conclusion, hyperventilation is not uniquely relevant for panic, but the degree of overlap between the two phenomena gives it a prominent role as a trigger for panic and a vehicle for successful psychological treatment.

In the mid to late 1980s, a number of psychological models of panic disorder were presented. These models share a number of similarities and have generated a wealth of research examining their assumptions. Following discussion of some basic terminological issues, the current paper proceeds to a brief description of some of the psychological models of panic disorder and then follows with a review of the major empirical support for them. Finally, a modification of an earlier model is presented, based on recent empirical findings.

A variety of pharmacological and physiological procedures reliably induce panic attacks in panic disorder patients but rarely do so in controls. Some biologically orientated researchers have described these procedures as biological challenge tests and have assumed that pharmacological and physiological manipulations have a direct panic-inducing effect and that individuals who are susceptible to these manipulations have a neurochemical disorder. An alternative explanation is provided by the cognitive theory of panic which proposes that the challenge tests induce panic because they produce bodily sensations that panic patients are prone to misinterpret and that it is the misinterpretation which is responsible for the induced attack. Experiments that have attempted to test the cognitive mediation account of biological challenge induced panic are reviewed. Overall, the results of these experiments provide strong support for the cognitive mediation hypothesis. In addition, it is suggested that the crucial cognitive variable is likely to be interpretation of challenge induced sensations, not expected affect or perceived control of the sensations.

The construct of anxiety sensitivity (AS) has occupied an increasingly important place in theorizing and research on anxiety and anxiety disorders. Although a number of recent studies have provided support for the construct validity of the principal operationalization of AS, the Anxiety Sensitivity Index (ASI), the relation of the AS construct and the ASI to trait anxiety continues to be a source of controversy. Key issues in the AS-trait anxiety debate include the assimilative nature of traits and the concept of incremental validity. Recent research on AS lends some support to the claim that trait anxiety cannot fully account for AS findings. Important areas for future AS research include (1) demonstrating that AS is a risk factor for panic disorder and related conditions, lather than simply a consequence of these conditions, (2) developing and utilizing multiple operationalizations of constructs, (3) minimizing the impact of potentially inapplicable items, (4) testing for interactions between AS and other variables, and (5) testing hierarchical factor models that allow trait anxiety and AS to coexist as higher- and lower-order factors, respectively. Researchers in this area will need to develop alternative measures of the AS construct, recognize the distinction between different levels of trait specificity, clarify a number of theoretical issues relevant to the AS construct, and continue to subject predictions to stringent theoretical risks.

This prospective study examined the role of personal and family factors during early adolescence in forecasting sexual activity, a behavior of major concern in the 1990s. Also, the correlates of late adolescent/young adult sexual activity, including delinquency and psychological adjustment, were examined. One hundred and thirty individuals were assessed at two points in time, during adolescence and six years later during late adolescence/young adulthood. Results supported the existing literature regarding the sexual activity of today's youth, indicating that the majority of both males and females are sexually active by late adolescence/young adulthood (age 18–21), and that the average adolescent/young adult has had multiple partners (females: 2–3; males: 3–4). For both males and females, adolescent sexual activity was correlated with problem behavior (i.e., delinquency), but rarely with prosocial behavior, during late adolescence/young adulthood. For females, but not for males, parental divorce during early adolescence was associated with earlier onset and greater frequency of sexual activity, as well as more sexual partners.

In the present study, 36 spider phobics received a one-session exposure in vivo treatment. It was investigated whether a monitoring (information seeking) coping style affected treatment outcome. In general, therapy appeared to be very successful. Yet, monitoring was found to be related to larger relapse at one week follow-up. This finding is in conflict with an earlier study of Steketee, Bransfield, Miller, and Foa (1989) that showed a favorable treatment outcome for monitors (information seekers) as compared to blunters (information avoiders). Potential explanations for the seemingly conflicting results are discussed.

Exercise therapy in patients with rheumatoid arthritis (RA) or osteoarthritis (OA) is controversial, because both improvement and deterioration of the patients' condition can be expected to occur. The literature was searched for studies on the outcome of exercise therapy in RA- and OA-patients. Twenty-four studies were identified, comprising nine controlled studies. In the present review, these studies are critically summarized. It was found that controlled studies have only reported improvements or non-significant results; deterioration of the patients' condition has not been reported. With regard to specific modalities of exercise therapy, it was found that aerobic exercise in RA-patients has been most thoroughly studied: improvements for specific categories of outcome (e.g., walking time and other sorts of observed disability) have been repeatedly reported, while for other categories of outcome (e.g., pain) non-significant results have been consistently reported. Several methodological deficiencies (concerning randomization, blinded evaluation and power) and assets (concerning compliance) in controlled studies are noted and evaluated. It is concluded that, despite several qualifications, the available evidence is in favor of exercise therapy in RA- and OA-patients. Neglected areas of research, including comparisons between subgroups of patients, are identified and suggestions for future research are given.