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© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Public safety personnel (PSP) often experience stress due to their occupational demands that affect the family environment (e.g., work-family conflict, marital breakdown, disruption to home routines, and holidays). A substantial base of research has focused on the impact of PSP work on the marital relationship, but fewer studies have focused specifically on children’s functioning within PSP families. The current study investigated mental health, well-being, and functioning among children of PSP in Canada, as reported by PSP. Data were collected between 2016 and 2017 as part of a large pan-Canadian study of PSP. Participants (n = 2092; 72.5% women) were PSP parents who responded to questions about their 4- to 17-year-old children. Overall, a substantial proportion of PSP parents reported their children have at least some difficulties with sadness (15.4%), worries and fear (22.0%), disobedience or anger (22.0%), attention (21.0%), and friendships (11.4%). Firefighters reported the fewest problems among their children compared to other PSP groups. Almost 40% of participants indicated that their child’s problems were related to their work as a PSP. The results highlight the need to find ways to identify children that are struggling and provide support to those families. Organizations and PSP leadership should develop and prioritize efforts to support families of PSP members, with the likely outcome of enhancing PSP member well-being. This research was supported by the Canadian Institute of Public Safety Research and Treatment (CIPSRT) and the Canadian Institute of Research in Health (CIHR). Specifically, R. N. Carleton’s Research was supported by the CIHR through a New Investigator Award (FRN: 285489) and a Catalyst Grant (FRN: 162545). Faculty yes

Background Nurses appear to be at a greater risk of burnout compared to other medical professionals. Higher levels of burnout are significantly associated with higher levels of anxiety, stress, and depression symptoms. Purpose The current study was designed to estimate levels of burnout among Canadian nurses, examine the association between burnout and mental disorder symptoms, and identify characteristics that may increase the risk for reporting symptoms of burnout. Method Canadian nurses ( n = 3257; 94.3% women) were surveyed online in both English and French. The survey assessed current symptoms of burnout and mental disorders (i.e., Posttraumatic Stress Disorder, Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder). Results Most nurses (63.2%) reported at least some symptoms of burnout and many (29.3%) reported clinically significant levels of burnout. Age and years of service were the only demographic variables that explained burnout rates. Participants reporting clinically significant levels of burnout were significantly more likely than participants with no burnout to screen positive for all mental disorders, but particularly for Major Depressive Disorder. Conclusions Monitoring burnout may be an effective way to identify nurses at risk of developing symptoms of mental disorders. Younger and early-career nurses are an important group to target for prevention programs.

Youth with chronic pain and their parents face uncertainty regarding their diagnosis, treatment, and prognosis. Given the uncertain nature of chronic pain and high comorbidity of anxiety among youth, intolerance of uncertainty (IU) may be critical to the experience of pediatric chronic pain. This study longitudinally examined major tenets of the Interpersonal Fear Avoidance Model of Pain and included parent and youth IU as key factors in the model. Participants included 152 youth with chronic pain (Mage = 14.23 years; 72% female) and their parents (93% female). At baseline, parents and youth reported on their IU and catastrophic thinking about youth pain; youth reported on their fear of pain, pain intensity, and pain interference; and parents reported on their protective responses to child pain. Youth reported on their pain interference 3 months later. Cross-lagged panel models, controlling for baseline pain interference, showed that greater parent IU predicted greater parent pain catastrophizing, which, in turn, predicted greater parent protectiveness, greater youth fear of pain, and subsequently greater youth 3-month pain interference. Youth IU had a significant indirect effect on 3-month pain interference through youth pain catastrophizing and fear of pain. The results suggest that parent and youth IU contribute to increases in youth pain interference over time through increased pain catastrophizing, parent protectiveness, and youth fear of pain. Thus, parent and youth IU play important roles as risk factors in the maintenance of pediatric chronic pain over time and may be important targets for intervention.

Persons with chronic musculoskeletal pain may be hypervigilant for pain-related cues, which paradoxically, may be maintaining their pain. Several randomized controlled trials have assessed whether a modified dot-probe protocol (i.e., attention bias modification; ABM) reduces chronic pain- and pain-related symptoms in persons with several diagnoses, including fibromyalgia. Scalability and economic efficiency potentiates the appeal of ABM protocols; however, research results have been mixed, with only some studies evidencing significant symptom gains from ABM and some evidencing gains for the control group. The current randomized controlled trial sought to replicate and extend previous ABM research using idiosyncratic word stimuli and a 1-month follow-up. Participants included treatment-seeking adult women (n=117) with fibromyalgia who were randomly assigned to a standard (i.e., control) or active (i.e., ABM) condition. The protocol was delivered online and involved twice-weekly 15-min sessions, for 4 weeks, with questionnaires completed at baseline, post-treatment, and 1-month follow-up. Symptom reports were analysed with mixed hierarchical modelling. There was no evidence of differences between the control and ABM groups. Both groups had small significant (ps.05). There were no significant changes for either group on measures of anxiety sensitivity, illness/injury sensitivity, pain-related fear, pain-related anxiety, or attentional biases (ps>.05). The current findings add to the emerging and mixed literature regarding ABM for pain by demonstrating that ABM produces no substantive improvements in pain or pain-related constructs in a large sample of patients with fibromyalgia. ispartof: Pain vol:161 issue:3 pages:584-594 ispartof: location:United States status: published

Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). First responders and other public safety personnel (PSP) experience elevated rates of mental disorders and face unique barriers to care. Internet-delivered cognitive behavioural therapy (ICBT) is an effective and accessible treatment that has demonstrated good treatment outcomes when tailored specifically for PSP. However, little is known about how PSP come to seek ICBT. A deeper understanding of why PSP seek ICBT can inform efforts to tailor and disseminate ICBT and other treatments to PSP. The present study was designed to (1) explore the demographic and clinical characteristics, motivations, and past treatments of PSP seeking ICBT, (2) learn how PSP first learned about ICBT, and (3) understand how PSP perceive ICBT. To address these objectives, we examined responses to online screening questionnaires among PSP (N = 259) who signed up for an ICBT program tailored for PSP. The results indicate that most of our sample experienced clinically significant symptoms of multiple mental disorders, had received prior mental disorder diagnoses and treatments, heard about ICBT from a work-related source, reported positive perceptions of ICBT, and sought ICBT to learn skills to manage their own symptoms of mental disorders. The insights gleaned through this study have important implications for ICBT researchers and others involved in the development, delivery, evaluation, and funding of mental healthcare services for PSP. This research was funded by PSPNET, which is funded by the Canadian Government’s Ministry of Public Safety and Emergency Preparedness. Faculty yes

Background Canadian public safety personnel (PSP) experience high rates of mental health disorders and face many barriers to treatment. Internet-delivered cognitive behavioral therapy (ICBT) overcomes many such barriers, and is effective for treating depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms. Objective This study was designed to fill a gap in the literature regarding the use of ICBT tailored specifically for PSP. We examined the effectiveness of a tailored ICBT program for treating depression, anxiety, and PTSD symptoms among PSP in the province of Saskatchewan. Methods We employed a longitudinal single-group open-trial design (N=83) with outcome measures administered at screening and at 8 weeks posttreatment. Data were collected between December 5, 2019 and September 11, 2020. Primary outcomes included changes in depression, anxiety, and PTSD symptoms. Secondary outcomes included changes in functional impairment; symptoms of panic, social anxiety, and anger; as well as treatment satisfaction, working alliance, and program usage patterns. Results Clients reported large symptom reductions on measures of depression and anxiety, as well as moderate reductions on measures of PTSD and secondary symptoms, except for social anxiety. Most clients who reported symptoms above clinical cut-offs on measures of depression, anxiety, and PTSD during screening experienced clinically significant symptom reductions. Results suggested good engagement, treatment satisfaction, and working alliance. Conclusions Tailored, transdiagnostic ICBT demonstrated promising outcomes as a treatment for depression, anxiety, and PTSD among Saskatchewan PSP and warrants further investigation. Trial Registration Clinicaltrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032

Background Nurses are regularly exposed to diverse potentially psychologically traumatic events (PPTEs) as a function of their work. Cumulative exposure to PPTEs can lead to clinically significant symptoms of mental disorders. Purpose We designed the current study to investigate the prevalence of different PPTEs among Canadian nurses and estimate the associations between diverse exposures and several mental disorders. Methods Canadian nurses (i.e., registered nurses, registered psychiatric nurses, licensed practical nurses, nurse practitioners) completed an online, self-reported survey. In total, 4067 participants (94.8% women) completed all relevant survey measures. Results Nurses reported exposures to several PPTE categories including severe human suffering, life threatening illness or injury, and physical assault, often 11 or more times. There were significant ( pConclusions The current findings suggest that Canadian nurses are substantially exposed to traumatic events, which vary by several sociodemographic categories. PPTE exposures were significantly associated with mental disorders; that is, if PPTEs were eliminated among Canadian nurses in the sample, symptoms would be reduced between 42.0% and 58.0%.

Poor sleep quality is associated with numerous mental health concerns and poorer overall physical health. Sleep disturbances are commonly reported by public safety personnel (PSP) and may contribute to the risk of developing mental disorders or exacerbate mental disorder symptoms. The current investigation was designed to provide estimates of sleep disturbances among PSP and explore the relationship between sleep quality and mental health status. PSP completed screening measures for sleep quality and diverse mental disorders through an online survey. Respondents (5813) were grouped into six categories: communications officials, correctional workers, firefighters, paramedics, police officers, and Royal Canadian Mounted Police (RCMP). Many PSP in each category reported symptoms consistent with clinical insomnia (49&ndash, 60%). Rates of sleep disturbances differed among PSP categories (p &lt, 0.001, &omega, = 0.08). Sleep quality was correlated with screening measures for post-traumatic stress disorder (PTSD), depression, anxiety, social anxiety disorder, panic disorder, and alcohol use disorder for all PSP categories (r = 0.18&ndash, 0.70, p &lt, 0.001). PSP who screened positive for insomnia were 3.43&ndash, 6.96 times more likely to screen positive for a mental disorder. All PSP reported varying degrees of sleep quality, with the lowest disturbances found among firefighters and municipal/provincial police. Sleep appears to be a potentially important factor for PSP mental health.

Public Safety Personnel (PSP, e.g., correctional workers and officers, firefighters, paramedics, police officers, and public safety communications officials (e.g., call center operators/dispatchers)) are regularly exposed to potentially psychologically traumatic events (PPTEs). PSP also experience other occupational stressors, including organizational (e.g., staff shortages, inconsistent leadership styles) and operational elements (e.g., shift work, public scrutiny). The current research quantified occupational stressors across PSP categories and assessed for relationships with PPTEs and mental health disorders (e.g., anxiety, depression). The participants were 4820 PSP (31.7% women) responding to established self-report measures for PPTEs, occupational stressors, and mental disorder symptoms. PPTEs and occupational stressors were associated with mental health disorder symptoms (ps &lt, 0.001). PSP reported substantial difficulties with occupational stressors associated with mental health disorder symptoms, even after accounting for diverse PPTE exposures. PPTEs may be inevitable for PSP and are related to mental health, however, leadership style, organizational engagement, stigma, sleep, and social environment are modifiable variables that appear significantly related to mental health.

Objectives Intolerance of uncertainty (IU) underlies several psychological disorders, and religion may help some individuals cope with IU and/or protect against psychological symptoms. It was hypothesized that IU would moderate the relations between coping motives for being religious, as well as religiosity, and common psychological disorder symptoms: Depression and social evaluation fears. Methods Study 1 included 473 self-reporting community members (M age = 48, 48% female, 80% Protestant/Catholic). Study 2 included 412 self-reporting undergraduates ( M age = 19, 71% female, 76% Protestant/Catholic). Results For Study 1, coping-based motives related to greater depression for young adults with above-average IU and to lower depression for young adults with below-average IU. For Study 2, religiosity related to lower depression and fear of negative evaluation for individuals with above-average IU and to greater fear of positive evaluation for individuals with below-average IU. Conclusion IU may be an important mechanism between aspects of religion and psychological disorder symptoms.

© 2019 Huang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The current study replicated and extended previous studies by examining the mediating and moderating role of rumination in the relationship between intolerance of uncertainty (IU) and depression in a community sample using both cross-sectional (n = 494; 56.9% female) and a two-months longitudinal (n = 321; 48.4% female) designs. Participants in each study were recruited through online crowdsourcing websites and completed study questionnaires. Results from Study 1 suggested that, while rumination did not appear to moderate the relationship between IU and depression, rumination appeared to partially mediates such relationship. Results from Study 2 supported rumination as fully mediating the relationship between IU and depression over two months. The brooding and reflection rumination subtypes exerted a significant indirect, but not moderating, effect on the relationship between IU and depression. Brooding exhibited a stronger mediation effect than did reflection. Overall, current results suggest that high levels of IU fuel the development of depression symptoms over time through engagement in heightened rumination. The IU-depression association appeared fully explained through rumination as it is a passive and contextually-dependent coping response that may enhance individuals’ emotion and facilitate the development of depressive symptoms. Faculty yes

© 2016 The Author. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). The current review and synthesis was designed to provocatively develop and evaluate the proposition that “fear of the unknown may be a, or possibly the, fundamental fear” (Carleton, 2016) underlying anxiety and therein neuroticism. Identifying fundamental transdiagnostic elements is a priority for clinical theory and practice. Historical criteria for identifying fundamental components of anxiety are described and revised criteria are offered. The revised criteria are based on logical rhetorical arguments using a constituent reductionist postpositivist approach supported by the available empirical data. The revised criteria are then used to assess several fears posited as fundamental, including fear of the unknown. The review and synthesis concludes with brief recommendations for future theoretical discourse as well as clinical and non-clinical research. R. N. Carleton’s research is supported by the Canadian Institutes of Health Research through a New Investigator Salary Award (FRN: 13666). Open Access for this publication was provided by the University of Regina President’s Publication Fund. Faculty yes

Intolerance of uncertainty (IU) – difficulty coping with uncertainty and its implications – is traditionally studied in adult populations, but more recently has been explored in children and adolescents. To date, the association between IU and health anxiety has not been explored in a child or adolescent sample. Further, it is unknown whether the relationship between IU and health anxiety may be mediated by anxiety sensitivity (i.e., fear of anxiety-related sensations) in this population. We sought to extend the existing research and expand our understanding of IU as a transdiagnostic construct by exploring the association between IU and health anxiety, anxiety sensitivity, and DSM-IV anxiety disorder symptom categories in 128 youth (M age = 12.7 years, SD = 0.82, range 11–17 years). Participants completed measures of IU, health anxiety, anxiety sensitivity, and anxiety disorder symptom categories. Results demonstrated significant positive associations between IU and all measures. Mediation analyses supported the direct and indirect importance of each IU subscale on health anxiety. Future directions and implications are discussed.

Interest in the relationship between intolerance of uncertainty (IU) and emotional disorders has rapidly increased over the last decade. Early theory and research focused on the relationship between IU and generalized anxiety disorder in particular; but, the roles that IU and the underlying 'fear of the unknown' play in the development, maintenance, and treatment of a broad array of emotional disorders have been explored more recently. This introduction provides a brief overview of the contributions to the special issue, which (a) summarize our current state of knowledge, (b) describe innovative methods for assessing and increasing our understanding IU within the context of various emotions and emotional disorders, (c) investigate associations between IU and therapeutic change, and (d) propose future research directions.

© 2016 The Author. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). The current review and synthesis serves to define and contextualize fear of the unknown relative to related constructs, such as intolerance of uncertainty, and contemporary models of emotion, attachment, and neuroticism. The contemporary models appear to share a common core in underscoring the impor- tance of responses to unknowns. A recent surge in published research has explored the transdiagnostic impact of not knowing on anxiety and related pathologies; as such, there appears to be mounting evidence for fear of the unknown as an important core transdiagnostic construct. The result is a robust foundation for transdiagnostic theoretical and empirical explorations into fearing the unknown and intolerance of uncertainty. Faculty yes

Cognitive vulnerabilities have been posited as central to the development of anxiety disorders and have been given substantial research attention. Despite widespread empirical investigations into the relationships with symptoms of mental disorders, and use as markers of symptom severity among clinical adult populations, research is lacking information on the progression of cognitive vulnerabilities across adulthood. The investments associated with longitudinal research requires a priori evidence of age-related differences from cross-sectional data. The current research used 1477 community members (72% female, 18–64 years) to cross-sectionally assess trends in cognitive vulnerabilities and their dimensions throughout adulthood and between distinct age groups (i.e., 18–19, 20–29, 30–39, 40–49, and 50+). Results suggest small, albeit statistically significant, associations with age which provide important insight into construct stability across adulthood and potentiate an avenue towards the understanding of progression across adulthood. Vulnerabilities encompassing somatic symptoms (i.e., fear of physiological sensations, injury, and illness) and uncertainty over future events (i.e., prospective-IU) exhibited positive linear relationships with age. Vulnerabilities encompassing fears of evaluation (i.e., fear of negative evaluation and socially observable anxiety), behavioral inhibition (i.e., inhibitory-IU), and loss of cognitive control (i.e., fear of cognitive dyscontrol) exhibited quadratic relationships with age. Participants over 50 years of age tended to report elevated cognitive vulnerabilities. Comprehensive results and directions for future research are discussed.

© 2018 the Author(s). published by Informa UK Limited, trading as Taylor & Francis group.this is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. Police agencies increasingly implement training programs to protect mental health. The Road to Mental Readiness (R2MR) program was designed by the Canadian military to increase mental health resilience. A version of R2MR was adapted for municipal police by the Mental Health Commission of Canada (MHCC). The current research was designed to assess the R2MR program, as adapted and delivered by the MHCC, in a municipal police sample. Participants were 147 Canadian police agency employees (57% women) who received a single R2MR training session. Participants completed pre- and post-training self-report questionnaires, and follow-ups at 6 and 12 months. The questionnaires assessed mental health symptoms, work engagement, resiliency, mental health knowledge, and stigma. Multilevel modeling analyses assessed for within-participant changes over time. The results were consistent with other single session interventions; specifically, there were no significant changes in mental health symptoms, resilience, or work engagement (p > .05). There were small, but significant (p < .05), reductions in stigma at post-training that may facilitate help-seeking among police; relatedly, in open-ended response fields, participants commonly described the training as helpful for changing attitudes and improving communication. More engagement with the material may produce larger, sustained gains, but more published research is critically needed. R. N. Carleton’s research is supported in part by the Canadian Institutes of Health Research (CIHR) through a New Investigator Award [grant number FRN: 285489]. Faculty yes

Anxiety levels have increased for several decades, despite objective indicators of historically unprecedented safety. A perceived inability to tolerate uncertainty or distress motivates individuals experiencing anxiety to engage in safety behaviors. Mobile phones provide unrestricted access to safety cues intended to reduce uncertainty and therein anxiety; however, recurrent engagement in reassurance seeking behaviors paradoxically increases anxiety. The current research was designed to assess whether self-reported intolerance of uncertainty (IU) levels may have been increasing and, if so, whether the increases correlate positively with mobile phone penetration and Internet usage. A cross-temporal meta-analysis was conducted using data from 52 North American studies exploring IU as well as social indicator data from several public sources. A statistically significant increase in IU levels occurred from 1999 to 2014, correlated with increases in mobile phone penetration and Internet usage. As hypothesized, IU levels appeared to be increasing over time and the increases correlate positively with mobile phone penetration and Internet usage. The results support the possibility that mobile phones increase reassurance seeking, acting as safety cues, and reducing spontaneous, everyday exposures to uncertainty, which may ultimately potentiate psychopathology by increasing IU and anxiety. Subsequent experimental research to assess for causality appears warranted. Limitations and directions for future research are presented.

Social Anxiety Disorder (SAD) models implicate social threat cue vigilance (i.e., attentional biases) in symptom development and maintenance. A modified dot-probe protocol has been shown to reduce SAD symptoms, in some but not all studies, presumably by modifying an attentional bias. The current randomized controlled trial was designed to replicate and extend such research. Participants included treatment-seeking adults (n = 108; 58% women) who met diagnostic criteria for SAD. Participants were randomly assigned to a standard (i.e., control) or modified (i.e., active) dot-probe protocol condition and to participate in-lab or at home. The protocol involved twice-weekly 15-min sessions, for 4 weeks, with questionnaires completed at baseline, post-treatment, 4-month follow-up, and 8-month follow-up. Symptom reports were assessed with repeated measures mixed hierarchical modeling. There was a main effect of time from baseline to post-treatment wherein social anxiety symptoms declined significantly (p.05) but depression and trait anxiety did not (p.05). There were no significant interactions based on condition or participation location (ps.05). Reductions were maintained at 8-month follow-up. Symptom reductions were not correlated with threat biases as indexed by the dot-probe task. The modified and standard protocol both produced significant sustained symptom reductions, whether administered in-lab or at home. There were no robust differences based on protocol type. As such, the mechanisms for benefits associated with modified dot-probe protocols warrant additional research.

Reiss (1991) described three “fundamental” fears-anxiety sensitivity, fear of negative evaluation, and injury/illness sensitivity-as distinct individual differences underlying fearful reactions. Taylor (1993) evidenced the distinctions, but the results have not been replicated despite developments in theory and measures. Intolerance of uncertainty and pain-related anxiety have since been posited as similarly important, but not established as distinct. The present investigation assessed for the distinctions (1) utilizing contemporary measures; (2) included intolerance of uncertainty and pain-related anxiety; and (3) employed a stringent process for assessing independence. Undergraduates and community members (n = 993; 71% women) randomly completed questionnaires assessing the constructs, with a “standard” format (i.e., each construct assessed as a grouped set of items) or a “random” format (i.e., items from all constructs randomly interspersed). The undergraduates (n = 254; 76% women) also provided data for two-week test–retest reliability. Factor analyses and test–retest reliability supported construct independence and stability across presentation formats. Comprehensive results, limitations, and directions for future research are discussed.

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). In this study, we used structural equation modeling to investigate the interplay among Intolerance of Uncertainty (IU), Anxiety Sensitivity (AS), and sleep problems. Three hundred undergraduate students completed the Intolerance of Uncertainty Scale, the Intolerance of Uncertainty Inventory, the Anxiety Sensitivity Index, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. 68% and 40% of the students reported poor sleep quality or sub-threshold insomnia problems, respectively. Depression and anxiety levels were above the cut-off for about one-fourth of the participants. Structural equation modeling revealed that IU was strongly associated with AS, in turn influencing both insomnia severity and sleep quality via depression and anxiety. Significant indirect effects revealed that an anxious pathway was more strongly associated with insomnia severity, while a depression pathway was more relevant for worsening the quality of sleep. We discussed the results in the frameworks of cognitive models of insomnia. Viewing AS and IU as antecedents of sleep problems and assigning to AS a pivotal role, our study suggested indications for clinical interventions on a population at risk for sleep disorders. Faculty yes

Intolerance of uncertainty has received substantial empirical attention in recent years. The contribution of intolerance of uncertainty to the development and maintenance of anxiety disorders has become increasingly recognized by researchers; however, relationships between intolerance of uncertainty and symptoms of posttraumatic stress disorder remain largely unexplored. As part of a larger study, North American community members (n = 122, 81 % women) with a heterogeneous trauma history completed self-report measures assessing intolerance of uncertainty and its dimensions (inhibitory and prospective intolerance of uncertainty) and posttraumatic stress disorder symptoms (re-experiencing, avoidance, numbing, hyperarousal). Intolerance of uncertainty total scores accounted for statistically significant variance in each posttraumatic stress disorder symptom score except re-experiencing. Inhibitory intolerance of uncertainty scores accounted for statistically significant variance in each posttraumatic stress disorder symptom score except re-experiencing. Prospective intolerance of uncertainty scores did not account for statistically significant variance in any of the posttraumatic stress disorder symptom scores. Results suggest that intolerance of uncertainty relates differentially to posttraumatic stress disorder symptom clusters and inhibitory intolerance of uncertainty appears to be the main component of the relationship.

Targeting constructs that contribute to positive and negative affect may lead to clinically significant reductions in symptoms of principal and co-occurring psychopathology. Anxiety sensitivity, the fear of negative evaluation, and illness/injury sensitivity have been described as three fundamental fears that underlie anxiety-related disorders. Despite the contemporary relevance of the fundamental fears, positive affect, and negative affect as treatment targets, research into how these constructs relate to each other remains scant. Community participants (n = 287) completed measures of affect and the fundamental fears. Canonical correlations, regression analyses, and moderator analyses revealed strong associations between negative affect and each of anxiety sensitivity, the fear of negative evaluation, and illness/injury sensitivity and a weaker but significant inverse relationship with positive affect. The fundamental fears shared a substantive amount of variance (42 %) with positive and negative affect, and this overlap may warrant attention from researchers and clinicians focusing on specific or transdiagnostic features of anxiety.

Tonic immobility (TI) is an involuntary state of temporary motor inhibition believed to occur in response to events that provoke extreme fear and the perception of inescapability. Human TI has been documented in a range of traumatic events and several researchers have reported associations between TI and posttraumatic stress symptoms (PTSS); however, it remains unclear if TI is a unique predictor of PTSS. This study was designed to determine whether TI severity would account for variance in PTSS severity over and above the influence of peritraumatic dissociation and trait anxiety. Participants were community members (n 75; 88% women; ages 18–65, Mage 31.49, SD 12.21) who reported TI during a traumatic event. TI, peritraumatic dissociation, and trait anxiety were assessed as part of a larger investigation. Results of hierarchical regression analyses indicated trait anxiety and peritraumatic dissociation, but not TI, were significant and substantive predictors of PTSS scores. In all analyses TI scores failed to account for significant variance in PTSS scores (all ps .05). Results suggest the TI construct may add little to understanding PTSS beyond what can be ascertained by assessing peritraumatic dissociation and trait anxiety. Given mixed findings to date, further investigation is required to disentangle what is shared and what is distinct among these constructs.

Intolerance of uncertainty (IU) - a dispositional characteristic resulting from negative beliefs about uncertainty and its implications - may be an important construct in anxiety disorders and depression. Despite the potential importance of IU, clinical data on the construct remains relatively scant and focused on generalized anxiety disorder and obsessive-compulsive disorder. The present study systematically investigated IU, as measured by the Intolerance of Uncertainty Scale-12 (IUS-12), across groups diagnosed with anxiety disorders (i.e., social anxiety disorder, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder) or depression (clinical sample: n=376; 61% women), as well as undergraduate (n=428; 76% women) and community samples (n=571; 67% women). Analysis of variance revealed only one statistically significant difference in IUS-12 scores across diagnostic groups in the clinical sample; specifically, people with social anxiety disorder reported higher scores (p

The association between anxiety sensitivity (AS) and posttraumatic stress disorder (PTSD) has been established in contemporary literature; however, research is divided over the nature of specific relationships between AS dimensions and PTSD symptoms clusters. Further, a paucity of research has examined the AS and PTSD relationship while accounting for theoretically relevant variables, such as negative (NA) and positive affect (PA). The purpose of the current study was twofold: first, to clarify divergent findings regarding the contribution of AS dimensions to PTSD symptom clusters, and, second, to further assess the relevance of NA and PA within the AS/PTSD relationship. Hierarchal regression analyses showed that, beyond shared variance attributable to NA and PA, AS somatic concerns were significantly associated with three of four PTSD symptom (i.e., reexperiencing, numbing, hyperarousal), AS cognitive concerns were only associated with hyperarousal, and AS socially observable symptoms were not significantly associated with any PTSD symptom clusters. These findings suggest that AS somatic concerns are the most robust predictor of variance within the AS/PTSD relationship and further clarify the theoretical importance of NA and PA within this relationship. Comprehensive results, implication, and directions for future research are discussed.

According to traditional conceptualizations of the relationship between fear of falling and falls in older adults, fear of falling is considered to be predictive of falls because it leads to activity avoidance which, in turn, leads to de-conditioning that increases fall risk. The recent literature has begun to challenge such conceptualizations. Specifically, it has been argued that fear of falling and anxiety, in and of themselves, have a direct negative effect on balance. In this study we manipulated anxiety level by asking older research participants to walk either on the floor (low anxiety condition) or an elevated platform (high anxiety condition). Half the time participants carried a tray (dual tasking) and half the time they did not. Manipulation checks (involving heart rate, galvanic skin response, and self-reported anxiety measurement) confirmed that the experimental manipulation was successful in affecting anxiety level. The results demonstrate that the experimental manipulation (platform vs. floor) affected balance parameters and dual tasking performance with the platform condition resulting in a less stable gait. In addition, increased task demand (i.e., dual tasking) also had a negative effect on balance performance. Finally, the results demonstrate that the paper and pencil measures of fear can also predict balance performance (although the variance accounted for is small) even after controlling for medical risk factors for falling. Implications for models of fear of falling are discussed.

There is a well-established and clinically meaningful relation between the cognitive-affective-based construct of anxiety sensitivity (AS) and risk for the development and maintenance of anxiety psychopathology (B. J. Cox, Fuentes, Borger, & Taylor, 2001). Research findings within this area have revealed mixed results; however, there is evidence to suggest that some individuals with anxiety disorder diagnoses may demonstrate enhanced subcortical arousal (e.g., exaggerated startle response to unexpected, aversive stimuli [A. M. Waters et al., 2008], and deficient prepulse inhibition [PPI; S. Ludewig, Ludewig, Geyer, Hell, & Vollenweider, 2002]), it is presently unclear whether these differences are found within the general population. To address this gap in the extant literature, the current investigation examined the impact of AS on acoustic startle response magnitude and PPI. Results indicated that individuals high and low in AS differ with regard to subcortical measures of arousal, with individuals expressing high levels of AS demonstrating enhanced startle response and deficient PPI. Results are discussed in terms of the role of the cognitive-affective-based factor of AS in the context of physiologic markers for vulnerability for anxiety psychopathology.

Cognitive-behavioral models conceptualize health anxiety as a construct that varies in degree along a continuum rather than existing as nonpathological versus pathological classes or taxons. Only two studies have empirically evaluated the latent structure of health anxiety, both using taxometric statistical methods and both supporting its conceptualization as continuous ( Ferguson, 2009 , Longley et al., 2010 ). We sought to further evaluate the latent structure of health anxiety using factor mixture modeling (FMM), which involved a combination of exploratory factor analysis (EFA) and mixture modeling that allowed comparison of models comprising one or more latent classes. Health anxiety symptom data were obtained from the Illness Attitude Scales (IAS) administered to 1768 university undergraduate students. Indicators of health anxiety, derived from EFA of IAS item data, included disease worry, disease conviction, health-related safety behaviors, fear of death, somatic focus, interference due to symptoms, and treatment seeking. FMM of these indicators suggested that health anxiety consists of two classes: (a) an “anxious” class comprising 81.4% of the sample and characterized primarily by somatic focus and interference due to symptoms, and (b) a “nonanxious” class comprising 18.6% of the sample with low scores on all indicators. Contrary to current conceptualizations and taxometric findings, the FMM results indicate the latent structure of health anxiety to be taxonic rather than continuous. Implications for the measurement and conceptualization of health anxiety are discussed and future research directions are highlighted.

Researchers have increasingly suggested that people with anxiety disorders share a common fear that the uncertain future will be catastrophic. Intolerance of uncertainty (IU) - the tendency to consider possible negative events as unacceptable and threatening, irrespective of probabilities - is representative of such fears. A key role has been indicated for IU in several anxiety and mood disorders; however, the present study appears to be the first latent structure examination of IU. Responses were obtained from a large sample (n=977; 65% women) unselected with regard to IU level, comprising anxiety disorder outpatients (i.e., putative taxon members), and community residents (i.e., putative complement class members). MAXEIG, MAMBAC, and L-Mode were performed with indicator sets drawn from the Intolerance of Uncertainty Scale-12. Assessments also included objective Comparison Curve Fit Indices. Results yielded converging evidence that IU symptoms have a dimensional latent structure. Comprehensive findings, implications, and future research directions are discussed.

Contemporary models of chronic musculoskeletal pain emphasize the critical roles of fear, anxiety, and avoidance as well as biases in attention in the development and maintenance of chronic pain disability. Evidence supports the influence of individual difference variables such as anxiety sensitivity, pain-related anxiety, and catastrophizing on the pain experience and on pain-related attentional biases. Changes in attentional biases have been associated with treatment gains in patients with clinically significant anxiety. The Attentional Modification Paradigm (AMP) is a modification of the dot-probe paradigm used to facilitate such changes in attentional biases. Given the relationship between chronic musculoskeletal pain and anxiety, AMP may be effective in reducing pain as well. Participants included persons (n = 17) with fibromyalgia and were randomly assigned to either an AMP condition or a control condition. The participants completed two 15-minute AMP sessions per week for 4 weeks. Those in the AMP condition reported statistically significant and substantial reductions on several individual difference variables relative to those in the control condition, and a greater proportion experienced clinically significant reductions in pain. These preliminary results offer a promising new avenue for treating chronic musculoskeletal pain that warrants additional research. Comprehensive results, limitations, and future directions are discussed.

The fear of negative evaluation (FNE) represents a fundamental component of social anxiety and social anxiety disorder (SAD) within modern cognitive-behavioral models (Clark & Wells, 1995; Rapee & Heimberg, 1997). As such, access to comprehensive psychometrics for measures of FNE is an important component of thorough clinical and research efforts. Among the most popular measures of FNE have been variations of the 12-item Brief Fear of Negative Evaluation (BFNE) scale (Leary, 1983). There are currently three versions of the BFNE based on two psychometric studies (i.e., two 8-item variants and a 12-item variant). There is still substantial debate regarding which of the three alternatives should be used by researchers and clinicians. Normative data for each of the three alternatives are not available across samples of individuals with diagnosed anxiety and mood disorders; moreover, there has been no comparative assessment of responses for such samples. The present investigation was to provide more definitive recommendations about the three alternatives, to provide normative clinical data, and to explore differences in FNE endorsement across anxiety and mood disorders. Clinical participants included 381 individuals (60% women; age M=35.61, SD=12.49) from an established anxiety treatment and research center. Diagnoses included those with a principal diagnosis of SAD (32%), those with a diagnosis of SAD as an additional disorder (24%), those without a diagnosis of SAD (41%), and those with features of SAD (3%). Results of descriptive analyses, factor analyses, analysis of variance, and receiver operating curves demonstrated that the 12-item variant of the BFNE was inferior or comparable to the two 8-item variants. FNE scores were consistently higher among all participants with a diagnosis of SAD (either principal or additional) relative to all other diagnostic groups (p

Recent evidence supports the notion that relatively common social events, such as public humiliation and teasing, may precipitate or exacerbate symptoms of social anxiety disorder (SAD; Erwin et al., 2006 , McCabe et al., 2010 ). In addition, individuals with SAD often report event-specific hallmark symptoms of posttraumatic stress (PTSS; e.g., intrusive memories, avoidance, hyperarousal) following significant negative social events. Although intriguing, there is a paucity of research data to date exploring the relationships between negative social events, social anxiety, and PTSS. The present study (1) assessed endorsement rates of negative social events; (2) compared patterns of social anxiety and PTSS reporting among persons reporting negative social events relative to persons reporting the Criterion A1 events associated with posttraumatic stress disorder; and (3) evaluated the interrelationships between social anxiety and PTSS, and common constructs including fear of negative evaluation, anxiety sensitivity, and depression. Participants included community members (n = 601; 74% women; Mage = 25.8, SD = 9.8) who endorsed experiencing a significantly negative social event. Approximately 55% of all participants reported experiencing a negative social event, with one-third of those indicating it was worse than the Criterion A events they had experienced. Participants reporting negative social events scored higher on measures of social anxiety and PTSS than those reporting only Criterion A events. Trauma symptoms only predicted social anxiety symptoms for participants who reported a negative social event. Comprehensive results and directions for future research are discussed.

It is now well established that chronic pain and various anxiety disorders frequently co-occur. Co-occurrence of chronic pain is often unrecognized in anxiety disorder settings; yet, when unaddressed, it can complicate treatment, reduce treatment effectiveness, and exacerbate functional limitations and suffering for patients. The purpose of this clinical synthesis is to describe the core features of clinically significant pain experiences, summarize findings from epidemiological studies of co-occurrence, describe biopsychosocial models and associated mechanisms posited to account for co-occurrence, and provide anxiety disorder practitioners with time-efficient pain assessment strategies and promising options for treating clinically significant pain presentations in their patients. Future directions are also briefly highlighted.

Exaggerated startle is a common symptom (based on Diagnostic and Statistical Manual of Mental Disorders [fourth edition] Criterion D) for many patients with posttraumatic stress disorder (PTSD). Findings from previous studies suggest that exaggerated startle may be due to trauma exposure or pretrauma vulnerability factors for PTSD development. The present clinical case study reports on a patient with PTSD characterized by a very prominent startle response and preference against standard trauma-related exposure strategies. On the basis of recent findings that interoceptive exposure exercises (e.g. shaking head side to side, hyperventilation) elicit trauma-related memories (Wald & Taylor, 2008), the authors sought to determine whether repeated application of an acoustic startle stimulus would serve to diminish the prominent startle response and facilitate exposure and overall symptom reduction by eliciting trauma-related memories. The protocol was successful in eliciting vivid and distressing trauma-related memories. Over the course of seven exposure trials, the patient demonstrated a decrease in distress elicited during the protocol, improved mood, and reduced general anxiety and trauma-related distress. He also reported significantly decreased startle response to loud noises encountered during activities of daily living. Although preliminary, these finding suggest that the acoustic startle protocol may be a viable (interoceptive) exposure strategy for individuals with PTSD, particularly those with exaggerated startle responses and those who are not amenable to standard trauma-related exposure strategies.

Copyright (c) 2018 Sebastian Harenberg, Michelle C. E. McCarron, R. Nicholas Carleton, Thomas O'Malley, Terry Ross. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/). Mental health in first responders and other public safety personnel has received substantial research attention in the past decade. Emergency medical services (EMS) demonstrate a heightened prevalence of maladaptive mental health concerns compared to other first responders (e.g., police, fire fighters). Interestingly, there is an absence of research examining helicopter emergency medical services (HEMS) personnel, who respond to what are often life-threatening cases in chal­lenging circumstances. Hence, the purpose of the present study was to assess the experiences of Posttraumatic Stress Disorder (PTSD) and associated mental health conditions (i.e., depression, anxiety, stress) in HEMS workers. HEMS work­ers from a single mid-western Canadian organization (n = 100) participated in the study. The participants completed the Posttraumatic Stress Disorder Checklist (PCL-5) and the Depression, Anxiety and Stress Scale (DASS-21) as part of an online survey. The results revealed that five per cent of HEMS personnel experienced heightened PTSD symptoms. Few participants exhibited signs of mild to severe depression, anxiety, and stress (< 17%). HEMS personnel experienced fewer mental health concerns than other first responder groups as reported in the literature; indeed, these figures are similar to levels observed within the general population. These findings may be explained by organizational or personality charac­teristics. Underreporting of mental health concerns may be an alternate explanation. Future qualitative and quantitative research is needed to explain and replicate the results of the present study. R. Nicholas Carleton’s research is supported by the Canadian Institutes of Health Research (CIHR) through a New Investigator Award (FRN: 13666). Faculty yes

Previous findings suggest that social anxiety disorder may be best characterized as having a dimensional latent structure (Kollman et al., 2006; Weeks et al., 2009). We attempted to extend previous taxometric investigations of social anxiety by examining the latent structure of social anxiety disorder symptoms in a large sample comprised of social anxiety disorder patients (i.e., putative taxon members) and community residents/undergraduate respondents (i.e., putative complement class members). MAXEIG and MAMBAC were performed with indicator sets drawn from a self-report measure of social anxiety symptoms, the Social Interaction Phobia Scale (Carleton et al., 2009). MAXEIG and MAMBAC analyses, as well as comparison analyses utilizing simulated taxonic and dimensional datasets, yielded converging evidence that social anxiety disorder has a taxonic latent structure. Moreover, 100% of the confirmed social anxiety disorder patients in our overall sample were correctly assigned to the identified taxon class, providing strong support for the external validity of the identified taxon; and k-means cluster analysis results corroborated our taxometric base-rate estimates. Implications regarding the conceptualization, diagnosis, and assessment of social anxiety disorder are discussed.

Intolerance of uncertainty (IU) is related to anxiety, depression, worry, and anxiety sensitivity. Precedent IU measures were criticized for psychometric instability and redundancy; alternative measures include the novel 45-item measure (Intolerance of Uncertainty Index; IUI). The IUI was developed in French with 2 parts, assessing general unacceptability of uncertainty (15 items, Part A) and manifestations of uncertainty approximating more common anxiety disorder symptoms (30 items, Part B). The psychometric stability of the back-translated English items of the IUI as well as the incremental variance of Parts A and B remain to be assessed. The current study involved 2 samples of English-speaking community participants (n = 437 and n = 309; 73% women and 27% men) who completed the IUI and several related measures. Exploratory and confirmatory factor analyses suggested a refinement of IUI items as well as a unitary structure for Part A and a 3-factor structure for Part B. Regression results suggested Parts A and B each provide incremental validity in measures of worry, generalized anxiety disorder symptoms, negative problem orientation, and depression. Comprehensive results, implications, and future research directions are discussed.

Interest in the role of intolerance of uncertainty (IU) - the tendency for a person to consider the possibility of a negative event occurring as unacceptable and threatening irrespective of the probability of its occurrence - in anxiety disorders has been increasing in recent research. IU has been implicated as an important construct associated with generalized anxiety disorder (GAD); however, a growing body of research suggests that levels of IU are also high among individuals with other anxiety disorders. Despite the increasing interest, few studies have examined the relationship between IU and social anxiety (SA). The purpose of the present investigation was to further investigate the relationship between IU and SA. Participants included 286 community members (71% women) from Canada who completed measures of IU, SA, anxiety sensitivity, and fear of negative evaluation (FNE). Regression analyses revealed that the inhibitory anxiety dimension of IU, the fear of socially observable anxiety symptoms dimension of anxiety sensitivity, and the FNE were consistently significant predictors of SA symptoms. Unexpectedly, IU and FNE were often comparable predictors of SA variance. Moreover, participants with SA symptoms consistent with SAD exhibited levels of IU comparable to those reported by participants with worry symptoms consistent with GAD. Comprehensive findings, implications, and directions for future research are discussed.

The Social Phobia Inventory (SPIN) was designed to assess three dimensions of social anxiety (i.e., fear, avoidance, and physiological arousal) as posited by the scale authors (Connor et al., 2000). Despite expectations of a 3-factor solution, analyses of the SPIN to date have provided support for 3- and 5-factor solutions (Radomsky et al., 2006). Moreover, a 3-item version, the Mini-SPIN (Connor et al., 2001), has good sensitivity and specificity for generalized social anxiety disorder (SAD), implying some item redundancy. Another recent psychometric analysis of the SPIN was performed in a diagnostically diverse clinical sample (Antony et al., 2006); however, the study did not include a comprehensive evaluation of the factor structure. The current study was designed to comprehensively assess the SPIN factor structure using exploratory (EFA) and confirmatory (CFA) factor analyses in undergraduate (N = 227) and clinical samples (N = 355) using current recommendations for factor analyses (Osborne et al., 2008). Results suggest a 10-item 3-factor solution may be an ideal fit for clinical samples; however, using the undergraduate sample, the same solution was significantly better than precedent solutions but nonetheless not ideal. Implications and recommendations for future research are discussed.

Fear–anxiety–avoidance models posit pain-related anxiety and anxiety sensitivity as important contributing variables in the development and maintenance of chronic musculoskeletal pain [Asmundson, G. J. G, Vlaeyen, J. W. S., & Crombez, G. (Eds.). (2004). Understanding and treating fear of pain. New York: Oxford University Press]. Emerging evidence also suggests that pain-related anxiety may be a diathesis for many other emotional disorders [Asmundson, G. J. G., & Carleton, R. N. (2005). Fear of pain is elevated in adults with co-occurring trauma-related stress and social anxiety symptoms. Cognitive Behaviour Therapy, 34, 248–255; Asmundson, G. J. G., & Carleton, R. N. (2008). Fear of pain. In: M. M. Antony & M. B. Stein (Eds.), Handbook of anxiety and the anxiety disorders (pp. 551–561). New York: Oxford University Press] and appears to share several elements in common with other fears (e.g., anxiety sensitivity, illness/injury sensitivity, fear of negative evaluation) as described by Reiss [Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11, 141–153] and Taylor [Taylor, S. (1993). The structure of fundamental fears. Journal of Behavior Therapy and Experimental Psychiatry, 24, 289–299]. The purpose of the present investigation was to assess self-reported levels of pain-related anxiety [Pain Anxiety Symptoms Scale-Short Form; PASS-20; McCracken, L. M., & Dhingra, L. (2002). A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Research and Management, 7, 45–50] across several anxiety and depressive disorders and to compare those levels to non-clinical and chronic pain samples. Participants consisted of a clinical sample (n = 418; 63% women) with principal diagnoses of a depressive disorder (DD; n = 22), panic disorder (PD; n = 114), social anxiety disorder (SAD; n = 136), obsessive-compulsive disorder (OCD; n = 86), generalized anxiety disorder (GAD; n = 46), or specific phobia (n = 14). Secondary group comparisons were made with a community sample as well as with published data from a treatment-seeking chronic pain sample [McCracken, L. M., & Dhingra, L. (2002). A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Research and Management, 7, 45–50]. Results suggest that pain-related anxiety is generally comparable across anxiety and depressive disorders; however, pain-related anxiety was typically higher (p

Current fear-anxiety-avoidance models of chronic pain emphasize pain-related fear and anxiety as potential precursors for disabling chronic pain; however, anxiety and fear are often used interchangeably when discussing pain. Fear is a present-oriented emotive state associated with an imminent threat (eg, a patient about to receive an injection), whereas anxiety is a more general, future-oriented emotive state, that occurs in anticipation of threats without requiring an objective stimulus (eg, the possibility of receiving an injection). Theoretical and empirical evidence suggests pain-related fear and anxiety represent distinct cognitive constructs. Moreover, pain-related anxiety has been posited as a manifestation of anxiety sensitivity, which has implications for several theo- retical models as well as treatment. The Fear of Pain Questionnaire and the Pain Anxiety Symptoms Scale-20 are popular measures, often used comparably, that were designed to measure pain-related fear and anxiety, respectively. These measures, along with the Anxiety Sensitivity Index, were administered to an undergraduate sample (N 268; 66% women). Results of confirmatory factor analyses suggest each measure represents a related, but distinct, construct. Furthermore, correlations with anxiety sensitivity suggest that pain-related anxiety may be better conceptualized as a funda- mental fear. Implications and directions for future research are discussed. Perspective: Fear-anxiety-avoidance models of chronic pain posit pain-related fear and anxiety as diatheses for disabling chronic pain. This research suggests theoretical and clinical distinctions be- tween pain-related fear and anxiety. Moreover, pain-related anxiety appears more complex than a manifestation of anxiety sensitivity; pain-related anxiety may be better conceptualized as a funda- mental fear. © 2009 by the American Pain Society

Health anxiety is an important but poorly assessed phenomenon. Manifesting along a continuum, health anxiety is the result of a catastrophic appraisal of somatic sensations and changes as indicative of disease. The Whiteley Index (WI) is one of the most widely used self-report measures for assessing health anxiety both for research and for clinical practice. It generally exhibits excellent and robust psychometric properties for internal consistency, test-retest reliability, convergent validity, and concurrent validity; however, both its item content and its factor structure are matters of debate. Moreover, the measure has rarely been assessed in nonclinical samples. For the present study, a sample of 300 participants from the University of Regina completed the WI. If the latent dimensions identified in factor analysis represent etiologic mechanisms, then the elucidation of the WI's factor structure may enhance our understanding of health anxiety. Exploratory factor analysis was used to determine a robust and reliable item content and factor structure, resulting in a six-item two-factor structure that was invariant across gender. The two factors were denoted Somatic Symptoms/Bodily Preoccupation and Disease Worry/Phobia. Previous factor structure solutions were compared to the factor structure derived from this study by means of confirmatory factor analysis. The newly established item content and factor structure resulted in acceptable fit indices that were statistically superior to those found using the previous factor structure solutions. Implications and directions for assessment of health anxiety and future research are discussed. Keywords: health anxiety; hypochondriasis; Whiteley Index; factor analysis Health anxiety occurs when bodily sensations or changes are interpreted as indicative of disease. The severity of health anxiety varies considerably from person to person; as such, contemporary cognitive-behavioral models (e.g., Salkovskis & Warwick, 1986; Taylor & Asmundson, 2004) conceptualize it along a continuum ranging from mild to severe. These models also conceptualize health anxiety as comprising several core features, including disease conviction (i.e., the belief that one has a serious disease), bodily preoccupation (i.e., attention to and rumination about the meaning of somatic sensations and changes), and diseaserelated fear (e.g., the fear that one has or may contract a serious disease). Maladaptive expressions of health anxiety typically occur when the anxiety is out of proportion with the objective degree of medical danger and are characterized by undue suffering, impairment in social and occupational functioning, persistent checking behaviors (e.g., surfing the Internet for medical information, palpating a lump under the skin), and reassurance seeking. In such cases, a person may be diagnosed with one of several health anxiety disorders, including hypochondriasis, abridged hypochondriasis (i.e., symptom presentations that fall short of full diagnostic criteria), and disease phobia (Asmundson & Taylor, 2007 ). There are several commonly used self-report measures that facilitate assessment of health anxiety and its core features (see Taylor & Asmundson, 2004). The Whiteley Index (WI; Pilowsky, 1967) was the first self-report measure developed for this purpose, and it remains among the most frequently used in research and clinical practice. The original version of the WI consisted of 14 items, each responded to on a dichotomous ( True or False ) scale, that purportedly measures three distinct components of health anxiety: disease conviction, bodily preoccupation, and disease-related fear (Pilowsky, 1967). The three subscales can be scored separately or summed to yield a total score, with higher scores indicating higher levels of health anxiety. Several modifications of the WI have been reported in the literature, including one version using a 5-point Likert response scale (Barsky, Wyshak, & Klerman, 1986) and various other versions that have reduced the number of items based on factor-analytic findings (e. …

Fears related to anxiety sensitivity (AS)-illness/injury sensitivity, fear of negative evaluation, and fear of pain-may have important theoretical associations with intolerance of uncertainty (IU). In separate investigations, AS and IU have been independently related to the same anxiety-related psychopathology. AS and IU seem to share a basis in fearing unknown, potentially harmful consequences; however, their inter-relationship remains uncertain. IU regarding a specific stimulus, a physical sensation for example, may result in a variety of interpretations and responses, including the catastrophic appraisals that characterize AS. The association between AS and IU was examined in a sample of 293 undergraduates. Results of confirmatory factor and correlation analyses suggest the two constructs are related, but nonetheless independent. It appears that IU may be a required component of catastrophic misappraisals while being an important construct related to fear and anxiety in its own right. Future research directions and potential applications are discussed.

Intolerance of uncertainty is the tendency of an individual to consider the possibility of a negative event occurring unacceptable, irrespective of the probability of occurrence. It is a key component of worry, state anxiety, and related anxiety pathologies. The 27-item Intolerance of Uncertainty Scale (IUS) was developed to measure intolerance of uncertainty. Previous psychometric analyses of the IUS have suggested both four- and five-factor models. High inter-item correlations, factor instability, and previous theoretical research support the development of a reduced measure. The present study used two undergraduate samples and evaluated a psychometrically stable 12-item two-factor version of the IUS. The reduced measure (IUS-12) retained exemplary internal consistency, while correlating extremely well with the original IUS and related measures of anxiety and worry. The IUS-12 also demonstrated a stable two-factor structure, representing both anxious and avoidance components of intolerance of uncertainty. Directions for future research and potential applications for assessment are discussed.

The Brief Fear of Negative Evaluation Scale [BFNE; Leary, M. R. (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371-375] is a self-report measure designed to assess fear of negative evaluation, a characteristic feature of social anxiety disorders [Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756]. Recent psychometric assessments have suggested that a 2-factor model is most appropriate, with the first factor comprising the straightforwardly worded items and the second factor comprising the reverse-worded items [Carleton, R. N., McCreary, D., Norton, P. J., & Asmundson, G. J. G. (in press-a). The Brief Fear of Negative Evaluation Scale, Revised. Depression & Anxiety; Rodebaugh, T. L., Woods, C. M., Thissen, D. M., Heimberg, R. G., Chambless, D. L., & Rapee, R. M. (2004). More information from fewer questions: the factor structure and item properties of the original and brief fear of negative evaluation scale. Psychological Assessment, 2, 169-181; Weeks, J. W., Heimberg, R. G., Fresco, D. M., Hart, T. A., Turk, C. L., Schneier, F. R., et al. (2005). Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder. Psychological Assessment, 17, 179-190]. Some researchers recommend the reverse-worded items be removed from scoring [e.g., Rodebaugh, T. L., Woods, C. M., Thissen, D. M., Heimberg, R. G., Chambless, D. L., & Rapee, R. M. (2004). More information from fewer questions: the factor structure and item properties of the original and brief fear of negative evaluation scale. Psychological Assessment, 2, 169-181; Weeks, J. W., Heimberg, R. G., Fresco, D. M., Hart, T. A., Turk, C. L., Schneier, F. R., et al. (2005). Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder. Psychological Assessment, 17, 179-190]; however [Carleton, R. N., McCreary, D., Norton, P. J., & Asmundson, G. J. G. (in press-a). The Brief Fear of Negative Evaluation Scale, Revised. Depression & Anxiety; Collins, K. A., Westra, H. A., Dozois, D. J. A., & Stewart, S. H. (2005). The validity of the brief version of the fear of negative evaluation scale. Journal of Anxiety Disorders, 19, 345-359] recommend that these items be reworded to maintain scale sensitivity. The present study examined the reliability and validity of the BFNE-II, a version of the BFNE evaluating revisions of the reverse-worded items in a community sample. A unitary model of the BFNE-II resulted in excellent confirmatory factor analysis fit indices. Moderate convergent and discriminant validity were found when BFNE-II items were correlated with additional independent measures of social anxiety [i.e., Social Interaction Anxiety & Social Phobia Scales; Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470], and fear [i.e., Anxiety Sensitivity Index; Reiss, S., & McNally, R. J. (1985). The expectancy model of fear. In S. Reiss, R. R. Bootzin (Eds.), Theoretical issues in behaviour therapy (pp. 107--121). New York: Academic Press. and the Illness/Injury Sensitivity Index; Carleton, R. N., Park, I., & Asmundson, G. J. G. (in press-b). The Illness/Injury Sensitivity Index: an examination of construct validity. Depression & Anxiety). These findings support the utility of the revised items and the validity of the BFNE-II as a measure of the fear of negative evaluation. Implications and future research directions are discussed.

Intolerance of Uncertainty (IU) appears to be a robust transdiagnostic risk factor related to anxiety and depression. Most transdiagnostic IU research has used the self-report Intolerance of Uncertainty Scale-Short Form; however, there is comparatively little research exploring presumed behavioral correlates of IU. The current study was designed to assess relationships between self-reported IU and decisions in uncertainty-based behavioral tasks (specifically, the Wisconsin Card Sorting Task, the Risky Gains Task, and the Modified Iowa Gambling Task). Participants comprised compensated community members (n = 108; 69% women) and undergraduates (n = 98; 78% women). Community member compensation was not contingent on performance, but undergraduate compensation was partially contingent on performance. Results replicated prior research, with both samples producing small (r = .19) to moderate (r = -.29) correlations (ps

The present study sought to extend our understanding as to how intolerance of uncertainty (IU) relates to information-processing by investigating associations between IU and attentional networks, including alerting, orienting, and executive attention. Based upon prior research, IU was expected to cluster with alerting. An unselected sample of college students (N=86; 79% women) completed self-report measures of IU and state anxiety, as well as the attention network test. Among the attentional networks, IU only shared a positive association with alerting and the association remained intact after statistically controlling for state anxiety. State anxiety did not moderate the association between IU and alerting. Although two IU dimensions (prospective and inhibitory) both shared a positive association with alerting, only prospective IU was associated with alerting after statistically controlling for state anxiety. The results provide evidence that IU relates to an overfunctioning of the alerting attentional network, which may suggest a role of hypervigilance and a greater influence of bottom-up processing in relation to IU. Implications for how these results advance our understanding of possible links between IU and anxiety disorders are discussed.