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The overall purpose of this study was to pilot a multibehavioral, brief, stroke self-care treatment adapted for implementation with underserved racial/ethnic minority groups and to test the moderating effects of anxiety and depression on engagement in secondary stroke-prevention behaviors. Fifty-two participants were randomized to the secondary stroke prevention (STOP) (N = 27) or usual care (N = 25) group. The STOP program consisted of 3 culturally tailored information sessions and goal-setting activities that were delivered in person by a research assistant. Participants were assessed at baseline and 4-week follow-up for stroke knowledge, exercise, fruit and vegetable consumption, tobacco and alcohol use, and medication adherence (primary outcomes) and anxiety and depression (moderator variables). Between-groups analysis of covariance and logistic multiple regressions revealed significant between-group differences for stroke knowledge, tobacco use and moderating effects between tobacco and anxiety, and improved alcohol use. The STOP program decreased secondary stroke risk factors among underserved racial/ethnic minorities and should be tested in large-scale trials. Keywords Stroke * Underserved ethnic minorities * Secondary stroke prevention * Stroke interventions * Anxiety * Depression, Introduction Approximately 700,000 people in the United States experience a first-episode stroke, and 200,000 experience a recurrent stroke, each year (American Heart Association, 2004). Approximately 13 % of stroke patients [...]

The authors pooled data from three independently conducted treatment outcome studies to examine predictors of outcome from group-administered cognitive-behavioral therapy (CBT) for older adults with generalized anxiety disorder (GAD). Data were collected from 65 patients with a mean age of 67.7 years (SD = 6.6). Average reliable change indices (RCI) based on 3 outcome measures were calculated at posttreatment and at 6-month follow-up. Approximately half of patients achieved a significant RCI at posttreatment and two-thirds achieved a significant RCI at follow-up. Factors associated with better outcomes included better homework adherence, higher baseline GAD severity, and presence of a comorbid psychiatric diagnosis. Results suggest that at-home practice is associated with better and longer-lasting outcomes from CBT in older adults with GAD.

Subsyndromal emotional symptoms are common in older adults and are associated with increased disability, health care utilization, and risk for developing psychiatric disorders. The purpose of this study was to examine subsyndromal generalized anxiety disorder (GAD) in older adults. Participants included 30 older adults with diagnosable GAD, 19 with subsyndromal anxiety symptoms [minor GAD; (MGAD)], and 21 normal control volunteers (NC). Participants were assessed using the Anxiety Disorders Interview Schedule for DSM-IV and completed self-report measures of anxiety, worry, depression, and life satisfaction. Excessive worry on more days than not, difficulty controlling worry, and clinically significant distress or impairment were the diagnostic criteria endorsed by MGAD participants least often. Therefore, these criteria may be useful in distinguishing between GAD and subsyndromal GAD. Self-reported anxiety and worry also systematically differed across groups in the expected directions, with a discriminant analysis yielding good classification of the GAD and NC groups based on these measures. Categorization of MGAD participants generally was poor, with most misclassified as GAD patients. Clinical implications of these findings are discussed. Keywords: Geriatric, Generalized anxiety disorder; Subsyndromal anxiety

This study addressed the efficacy of cognitive-behavioral therapy (CBT), relative to minimal contact control (MCC), in a sample of 85 older adults (age 60 years and over) with generalized anxiety disorder (GAD). All participants completed measures of primary outcome (worry and anxiety), coexistent symptoms (depressive symptoms and specific fears), and quality of life. Results of both completer and intent-to-treat analyses revealed significant improvement in worry, anxiety, depression, and quality of life following CBT relative to MCC. Forty-five percent of patients in CBT were classified as responders, relative to 8% in MCC. Most gains for patients in CBT were maintained or enhanced over 1-year follow-up. However, posttreatment scores for patients in CBT failed to indicate return to normative functioning.

Research supports the validity of Spanish-language translations of questionnaires used to measure anxiety and related disorders. Assessments of validity involved the use of bilingual participants who answered English- and Spanish-language questionnaires and produced comparable results from both.

A survey of 71 graduates of the psychology residency program at The University of Texas Houston Medical School and the Texas Research Institute of Mental Science indicated that two-thirds of the respondents were involved in private practice, conducting primarily individual therapy, with assessment also playing a major role in their practice. Managed care had the effect of placing limits on the numbers of sessions available to patients, reducing income, and increasing paperwork associated with practice. Implications for training during residency are that individual therapy, using focused short-term approaches, and assessment should continue to be the primary clinical experiences for trainees, and that there should also be training in the business aspect of practice, including marketing.

Recent epidemiological studies have reported an increased risk of suicide in patients with panic disorder, raising the possibility that there may be a unique relationship between panic and suicide. However, other studies, such as large chart reviews, have not found a meaningful increase in suicidal behavior among panic patients, except in those patients with comorbid borderline personality diagnoses. The present study examined nonclinical panickers to explore the specificity of the relationship between panic and suicide. Six hundred and twenty-seven undergraduates were surveyed to assess experiences of panic, suicidal behavior in relation to panic and general levels of pathology. Forty-two percent of the sample had experienced at least one panic attack in the past year, and of those 18% had considered suicide and 2.65% had made a suicide attempt in relation to their panic attacks. In comparison to nonclinical panickers who did not consider suicide, ideating nonclinical panickers had more frequent attacks, considered their attacks to be more severe, and viewed themselves as more fearful and in less control of their attacks. They also endorsed significantly higher levels of pathology across every dimension assessed. Results are discussed in terms of the prevalence of suicidal ideation among nonclinical samples, associated psychopathology, and extrapolation of the findings to clinical samples allowing development of models to understand the relationship between panic and suicide.

In recent years, behavior therapists have made a deliberate effort to expand their horizons to include underserved populations. The application of behavioral and cognitive behavioral procedures to anxiety disorders in the elderly represents one such beginning effort. In this review, we will present an overview of available literature concerning the psychopathology, assessment, and behavioral treatment of the anxiety disorders in later life. As will be noted, research is beginning to elucidate specific features and treatment of anxiety in the elderly, although the majority of this attention has been directed at Generalized Anxiety Disorder, specific phobias, and non-clinical anxiety complaints. Areas for future research are highlighted throughout this review, in the hopes of stimulating increased attention in these areas.

Despite relatively high prevalence rates of anxiety disorders in older adults, little attention has been paid to the establishment of psychometrically sound measures for this population. The current study addresses this issue by examining the psychometric properties of four self-report anxiety measures: the Spielberger State-Trait Anxiety Inventory (STAI), Worry Scale (WS), Fear Questionnaire (FQ), and Padua Inventory (PI). Two older adult community subsamples were assessed, one with Generalized Anxiety Disorder (GAD; n = 50) and the other with no anxiety complaints (Normal Controls: NC; n = 94). Descriptive data revealed that mean scores in the GAD sample were similar to those reported in studies of younger GAD patients. Mean scores in the NC sample, however, were lower than those reported in studies of younger control samples. Internal consistency for all measures generally was adequate in both the GAD and NC subsamples, although alpha coefficients for two of the FQ subscales were marginal. Test-retest reliability over a 2-4 week interval (assessed in a subgroup of NC subjects) was mixed, with some measures apparently assessing stable, trait-like dimensions of fear and anxiety, and others estimating more state-like clinical features. Intercorrelations among subscales for all four measures in both the GAD and NC groups generally were high and consistent with findings from prior research. Finally, some support for the convergent validity of the four anxiety measures was obtained, particularly in the NC sample. Results are discussed in terms of the utility of these instruments for future investigations of the psychopathology and treatment of anxiety disorders in the elderly.

Generalized Anxiety Disorder (GAD) in older adults has received little attention from researchers, despite evidence that anxiety disorders are a significant mental health problem in this population. This study compared the efficacy of cognitive behavior therapy (CBT) and nondirective, supportive psychotherapy (SP) for 48 older adults, ages 55 and up, with well-diagnosed GAD. Treatments were administered in small groups that met for 14 weekly 1 1/2 hour sessions. Treatment effects were assessed at posttreatment and over a 6-month follow-up period. Primary outcome variables targeted anxiety and worry, and transfer effects were assessed with measures of depression and associated fears. Two composite indexes of treatment response were derived to identify treatment responder status and high endstate functioning. Two participants declined participation prior to randomization; 15 others were classified as drop-outs. Results for the remaining 31 participants (CBT: n = 18; SP: n = 13) demonstrated significant improvements on primary outcome and transfer effect variables in both treatment conditions. Effect sizes generally were large, and treatment gains were maintained or improved over the 6-month follow-up phase. Examination of treatment responder status and endstate functioning revealed no significant differences between groups. The data support the potential efficacy of psychosocial group treatment for GAD in older adults, although limitations of the work and suggestions for future research are discussed.

This study investigated the extent to which adolescents believe the health warning labels on cigarette packs, and the relationship of current smoking status and gender to the believability ratings. Subjects were 691 students in grades 5 through 12. MANOVAs revealed that, smokers, both male and female, reported significantly less belief in the validity of 3 of the health warning labels than nonsmokers. These findings support prior investigations which indicate that adolescent smokers are less likely to accept the specific health risks associated with smoking than nonsmokers. The results, however, also raise the question as to what value such health warning labels have as a deterrent to cigarette smoking.

Despite the prevalence of Generalized Anxiety Disorder (GAD) in older adults, little is known about psychopathological features of excessive worry in the elderly. This investigation compared 44 GAD patients ([mean] age 67.6), diagnosed using structured interview, with a matched sample free of psychiatric disorders on self-report and clinician measures. Results indicated that GAD in the elderly is associated with elevated anxiety, worry, social fears, and depression. Using self-report measures alone, near-perfect classification of Ss into groups was achieved with four measures (PSWQ, WS-Soc, FQ-Soc, and BDI). Using clinician ratings, near-perfect classification was achieved with Hamilton anxiety ratings. Comparison of GAD patients whose symptoms began in childhood vs middle adulthood revealed few differences on these dimensions. Results are discussed in light of features of GAD in the elderly, highlighting implications for further study.

A study of 144 psychiatric outpatients aged 21 to 67 years who completed the Multidimensional Scale of Perceived Social Support (MSPSS) and the Network Orientation Scale (NOS) showed high internal consistency for the MSPSS and adequate internal consistency for the NOS. This indicated that the MSPSS and the NOS are reliable self-report scales although there are some limitations. The scores on both scales of these outpatients were lower as compared to 'normals.'

Behavioral and pharmacological treatment outcome studies of obsessive-compulsive disorder (OCD) are reviewed, and a synthesis of findings regarding posttreatment response and durability of treatment effects is offered. An analysis of differential treatment response rates is presented within the context of drop-out and relapse rates. In addition, the role of individual variables and the presence of comorbid conditions are discussed in relation to outcome. Although both drug and behavioral treatments are efficacious, within the confines of limitations in currently available research, it appears that behavioral treatment incorporating exposure (flooding) and response prevention produces the larger response rates, particularly when relapse and drop-out rates are considered. However, the measurement strategies employed by the two literatures have differed considerably, and these issues are highlighted. Finally, based on the extant literature, critical needs for future drug and behavioral studies are noted.

Current approaches to the treatment of panic disorder (PD) include a treatment package consisting of relaxation training (RT), cognitive therapy (CT), and exposure-based components. In an examination of the separate effects of RT and CT without formally taught exposure of any form, 64 PD patients were assigned randomly to one of these treatment protocols or to a minimal-contact control (MCC) condition. Both RT and CT were superior to the MCC condition on a variety of measures pertaining to panic, global psychological functioning, agoraphobic fear, and other associated fears. A significantly greater percentage of patients were classified as treatment responders (based on a composite index) after CT (82%) and RT (68%), compared with the control group (36%). On measures of agoraphobic fear, CT patients fared slightly better than RT patients. Some support was demonstrated for specific cognitive changes after CT, although treatment specificity was not strongly supported overall. These results are discussed in light of current theories of PD and the presumed importance of exposure in its treatment.

Given recent conceptualizations of trichotillomania (TM) as a variant of obsessive compulsive disorder (OCD), clinician-rated measures of obsessive compulsive symptoms have been adapted for use in the assessment of TM. Although the reliability and validity of these instruments have been well-documented in patients with OCD, psychometric properties have not been examined systematically in patients with TM. Here, we evaluate the reliability and validity of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) in a sample of 11 patients with a primary diagnosis of TM. Data addressed the utility of the Y-BOCS for evaluating symptoms of TM, and provided information regarding the proposed overlap between OCD and TM. Initial analyses suggested that interrater reliability, internal consistency, and test-retest reliability for the total score were adequate. However, the range of scores was somewhat restricted, and suggested in particular that interference in daily functioning from TM symptoms is quite low. Both internal consistency and test-retest reliability for the Target Behaviors subscale were inadequate, suggesting that this combined score is inappropriate for use with TM patients. Concurrent validity data using the total score were mixed, although the Y-BOCS did appear to be sensitive to change in TM symptoms over treatment. Implications for the use of the Y-BOCS with TM patients and hypothesized phenomenological differences between TM and OCD are discussed.

Summary - Recently, information processing paradigms have been utilized to explore the role of attentional and memory processes in the maintenance of clinical anxiety disorders. The present study extended these data using a dual-task paradigm to assess attentional vigilance and a cued recognition task to evaluate short-term memory effects in Panic Disorder (PD). Twenty PD patients and 20 normal controls completed a computerized task wherein they read aloud one of a pair of rapidly presented words (primary task) while simultaneously attempting to detect a small probe that appeared adjacent to one of the words (secondary task). Eighty stimulus words were chosen to represent four categories: physical panic-related threat, social threat, positive-emotional, and neutral. Reaction time and accuracy in detecting the probe were assessed, as well as psychophysiological responding (heart rate, skin conductance, EMG). Following task completion, a cued recognition task was administered to examine short-term memory of task stimuli. Results indicated that PD patients exhibited slower reaction times relative to normal controls during presentation of physical panic-related threat and positive-emotional stimuli. A similar trend emerged for social threat stimuli, although the PD and control samples responded similarly to neutral stimuli. No group differences were found on the cued recognition measure or psychophysiological responding during task performance. The data are discussed in terms of possible implications for cognitive models of PD.

The presence of Axis I and Axis II disorders in 71 social public phobic patients was examined. Generalized anxiety disorder was the most common secondary Axis I disorder, followed by simple phobia. Avoidant personality disorder and obsessive-compulsive personality disorder were the most common Axis II diagnoses, and 88% of the sample exhibited features of these 2 personality styles. Subjects with additional Axis I diagnoses were more anxious and depressed than those with no additional Axis I disorder. Social phobics with additional Axis II disorders were more depressed but not more anxious than those with no Axis II diagnosis. Furthermore, those with an additional Axis I disorder had higher scores on measures of neuroticism, interpersonal sensitivity, and agora-phobia. The prevalence and impact of additional Axis I and II disorders on the etiology, maintenance, and treatment outcome for persons with social phobia are discussed.

Veterans with posttraumatic stress disorder (PTSD) consistently evidence higher rates of intimate partner aggression perpetration than veterans without PTSD, but most studies have examined rates of aggression among Vietnam veterans several years after their deployment. The primary aim of this study was to examine partner aggression among male Afghanistan or Iraq veterans who served during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) and compare this aggression to that reported by Vietnam veterans with PTSD. Three groups were recruited, OEF/OIF veterans with PTSD (n = 27), OEF/OIF veterans without PTSD (n = 31), and Vietnam veterans with PTSD (n = 28). Though only a few comparisons reached significance, odds ratios suggested that male OEF/OIF veterans with PTSD were approximately 1.9 to 3.1 times more likely to perpetrate aggression toward their female partners and 1.6 to 6 times more likely to report experiencing female perpetrated aggression than the other two groups. Significant correlations among reports of violence perpetrated and sustained suggested many men may have been in mutually violent relationships. Taken together, these results suggest that partner aggression among Iraq and Afghanistan veterans with PTSD may be an important treatment consideration and target for prevention.

Anxiety disorders occur in about 4% to 10% of community samples of older adults, and anxiety symptoms that do not meet criteria for a disorder affect 15% to 20%. (1-5) [...]

Two questionnaires that are extensively used over the telephone to obtain self-report measures of worry and depression amongst older adults are examined for their psychometric properties.

Examination of 83 older participants with generalized anxiety disorder through the Cognitive Checklist (CCL) and the Positive and Negative Affect Schedule (PANAS) was conducted. Studies revealed a 3-factor solution for the PANAS and a 2-factor solution for CCL.

A confirmatory factor analysis of the Penn State Worry QuestionnaireEs (PSWQ) data was conducted to evaluate the generalizability of previous models to older adults with generalized anxiety disorder. Studies revealed that the data fit poorly with established single and two factor models.

Anxiety is a major health problem for older adults. The cornerstone for further work in this area is research that establishes the psychometric utility of standardized measurement strategies to characterize anxiety in older adults. The goals of the current study were to replicate and extend prior research addressing the psychometric properties of five self-report measures of anxiety in a sample of 57 older adults with generalized anxiety disorder (GAD). Data addressed the descriptive characteristics, internal consistency, test-retest reliability, interrelation of subscales, and convergent and divergent validity of the Penn state worry questionnaire (PSWQ), worry scale (WS), Spielberger state-trait anxiety inventory -- Form Y (STAI), and two versions of the fear questionnaire (FQ). Descriptive data generally replicated prior findings, with some increased state and trait anxiety in the current sample. Measures were internally consistent, with evidence that a revised version of the FQ that focuses on severity of fear irrespective of associated avoidance demonstrated greater internal consistency than the original version. Measures of content-specific fears and worries (WS, FQ) were stable over time and demonstrated convergent validity. Evidence of convergent validity also was evident for measures of worry and general anxiety (WS, PSWQ, STAI-Trait), but two of these measures (PSWQ, STAI) were not reliable over time. Only the PSWQ showed evidence of divergent validity with respect to self-report measures of depression. [C] 2001 Elsevier Science Ltd. All rights reserved. Keywords: Anxiety; Elderly; Assessment