The Effect of Disgust and Fear Modeling on Children’s Disgust and Fear for Animals

PubMed Central

2014-01-01

Disgust is a protective emotion associated with certain types of animal fears. Given that a primary function of disgust is to protect against harm, increasing children’s disgust-related beliefs for animals may affect how threatening they think animals are and their avoidance of them. One way that children’s disgust beliefs for animals might change is via vicarious learning: by observing others responding to the animal with disgust. In Experiment 1, children (ages 7–10 years) were presented with images of novel animals together with adult faces expressing disgust. Children’s fear beliefs and avoidance preferences increased for these disgust-paired animals compared with unpaired control animals. Experiment 2 used the same procedure and compared disgust vicarious learning with vicarious learning with fear faces. Children’s fear beliefs and avoidance preferences for animals again increased as a result of disgust vicarious learning, and animals seen with disgust or fear faces were also rated more disgusting than control animals. The relationship between increased fear beliefs and avoidance preferences for animals was mediated by disgust for the animals. The experiments demonstrate that children can learn to believe that animals are disgusting and threatening after observing an adult responding with disgust toward them. The findings also suggest a bidirectional relationship between fear and disgust with fear-related vicarious learning leading to increased disgust for animals and disgust-related vicarious learning leading to increased fear and avoidance. PMID:24955571

Pain-catastrophizing and fear-avoidance beliefs as mediators between post-traumatic stress symptoms and pain following whiplash injury - A prospective cohort study.

PubMed

Andersen, T E; Karstoft, K-I; Brink, O; Elklit, A

2016-09-01

Knowledge about the course of recovery after whiplash injury is important. Most valuable is identification of prognostic factors that may be reversed by intervention. The mutual maintenance model outlines how post-traumatic stress symptoms (PTSS) and pain may be mutually maintained by attention bias, fear, negative affect and avoidance behaviours. In a similar vein, the fear-avoidance model describes how pain-catastrophizing (PCS), fear-avoidance beliefs (FA) and depression may result in persistent pain. These mechanisms still need to be investigated longitudinally in a whiplash cohort. A longitudinal cohort design was used to assess patients for pain intensity and psychological distress after whiplash injury. Consecutive patients were all contacted within 3 weeks after their whiplash injury (n = 198). Follow-up questionnaires were sent 3 and 6 months post-injury. Latent Growth Mixture Modelling was used to identify distinct trajectories of recovery from pain. Five distinct trajectories were identified. Six months post-injury, 64.6% could be classified as recovered and 35.4% as non-recovered. The non-recovered (the medium stable, high stable and very high stable trajectories) displayed significantly higher levels of PTSS, PCS, FA and depression at all time points compared to the recovered trajectories. Importantly, PCS and FA mediated the effect of PTSS on pain intensity. The present study adds important knowledge about the development of psychological distress and pain after whiplash injury. The finding, that PCS and FA mediated the effect of PTSS on pain intensity is a novel finding with important implications for prevention and management of whiplash-associated disorders. WHAT DOES THIS STUDY ADD?: The study confirms the mechanisms as outlined in the fear-avoidance model and the mutual maintenance model. The study adds important knowledge of pain-catastrophizing and fear-avoidance beliefs as mediating mechanisms in the effect of post-traumatic stress on pain intensity. Hence, cognitive behavioural techniques targeting avoidance behaviour and catastrophizing may be beneficial preventing the development of chronic pain. © 2016 European Pain Federation - EFIC®

Physical activity during work and leisure show contrasting associations with fear-avoidance beliefs: cross-sectional study among more than 10,000 wage earners of the general working population.

PubMed

Tribian, Annika; Vinstrup, Jonas; Sundstrup, Emil; Jay, Kenneth; Bös, Klaus; Andersen, Lars L

2018-01-26

The association between different types of physical activity and fear-avoidance beliefs remains unclear. This study investigates the association between work-related and leisure-time physical activity with fear-avoidance beliefs in the general working population. Currently employed wage earners (n=10,427) from the 2010 round of the Danish Work Environment Cohort Study replied to questions about work, lifestyle and health. General linear models controlling for lifestyle, psychosocial work factors, education, pain, medication-use and chronic diseases tested associations of work-related and leisure-time physical activity (explanatory variables) with fear-avoidance beliefs (outcome variable, scale 0-100). The level of fear-avoidance was 41.7 (SD 27.3), 38.0 (SD 26.9) and 54.3 (SD 27.7) among the general working population, a subgroup of pain-free individuals, and a subgroup with back disease, respectively. In the general working population, the level of fear-avoidance among those with low, moderate and high physical activity during leisure were 47 [95% confidence intervals (CI) 45-49], 44 (95% CI 42-46) and 43 (95% CI 41-45), and physical activity at work were 40 (95% CI 39-42), 44 (95% CI 42-46) and 49 (95% CI 48-51), respectively. Individuals with back disease and a high level of physical activity at work showed the overall highest level of fear-avoidance whereas pain-free individuals with a low level of physical activity at work showed the overall lowest level of fear-avoidance. Physical activity during work and leisure shows contrasting associations with fear-avoidance beliefs. While high physical activity during leisure is associated with lower levels, high physical activity at work is associated with higher levels of fear-avoidance. The present results may reflect some deeply rooted negative beliefs about pain and work in the population. On the societal level, campaigns may be a possible way forward as these have shown to improve beliefs about musculoskeletal pain and work.

Passive avoidance is linked to impaired fear extinction in humans

PubMed Central

Cornwell, Brian R.; Overstreet, Cassie; Krimsky, Marissa; Grillon, Christian

2013-01-01

Conventional wisdom dictates we must face our fears to conquer them. This idea is embodied in exposure-based treatments for anxiety disorders, where the intent of exposure is to reverse a history of avoidant behavior that is thought to fuel a patient’s irrational fears. We tested in humans the relationship between fear and avoidance by combining Pavlovian differential fear conditioning with a novel task for quantifying spontaneous passive avoidant behavior. During self-guided navigation in virtual reality following de novo fear conditioning, we observed participants keeping their distance from the feared object. At the individual level, passive avoidant behavior was highly associated with maladaptive fear expression (fear-potentiated startle) during late extinction training, indicating that extinction learning was impaired following a brief episode of avoidance. Avoidant behavior, however, was not related to initial acquired fear, raising doubt about a straightforward link between physiological fear and behavioral avoidance. We conclude that a deeper understanding of what motivates avoidance may offer a target for early intervention, before fears transition from the rational to the irrational. PMID:23427168

Predictive Validity of Explicit and Implicit Threat Overestimation in Contamination Fear

PubMed Central

Green, Jennifer S.; Teachman, Bethany A.

2012-01-01

We examined the predictive validity of explicit and implicit measures of threat overestimation in relation to contamination-fear outcomes using structural equation modeling. Undergraduate students high in contamination fear (N = 56) completed explicit measures of contamination threat likelihood and severity, as well as looming vulnerability cognitions, in addition to an implicit measure of danger associations with potential contaminants. Participants also completed measures of contamination-fear symptoms, as well as subjective distress and avoidance during a behavioral avoidance task, and state looming vulnerability cognitions during an exposure task. The latent explicit (but not implicit) threat overestimation variable was a significant and unique predictor of contamination fear symptoms and self-reported affective and cognitive facets of contamination fear. On the contrary, the implicit (but not explicit) latent measure predicted behavioral avoidance (at the level of a trend). Results are discussed in terms of differential predictive validity of implicit versus explicit markers of threat processing and multiple fear response systems. PMID:24073390

Fear-avoidance beliefs and temporal summation of evoked thermal pain influence self-report of disability in patients with chronic low back pain.

PubMed

George, Steven Z; Wittmer, Virgil T; Fillingim, Roger B; Robinson, Michael E

2006-03-01

Quantitative sensory testing has demonstrated a promising link between experimentally determined pain sensitivity and clinical pain. However, previous studies of quantitative sensory testing have not routinely considered the important influence of psychological factors on clinical pain. This study investigated whether measures of thermal pain sensitivity (temporal summation, first pulse response, and tolerance) contributed to clinical pain reports for patients with chronic low back pain, after controlling for depression or fear-avoidance beliefs about work. Consecutive patients (n=27) with chronic low back pain were recruited from an interdisciplinary pain rehabilitation program in Jacksonville, FL. Patients completed validated self-report questionnaires for depression, fear-avoidance beliefs, clinical pain intensity, and clinical pain related disability. Patients also underwent quantitative sensory testing from previously described protocols to determine thermal pain sensitivity (temporal summation, first pulse response, and tolerance). Hierarchical regression models investigated the contribution of depression and thermal pain sensitivity to clinical pain intensity, and fear-avoidance beliefs and thermal pain sensitivity to clinical pain related disability. None of the measures of thermal pain sensitivity contributed to clinical pain intensity after controlling for depression. Temporal summation of evoked thermal pain significantly contributed to clinical pain disability after controlling for fear-avoidance beliefs about work. Measures of thermal pain sensitivity did not contribute to pain intensity, after controlling for depression. Fear-avoidance beliefs about work and temporal summation of evoked thermal pain significantly influenced pain related disability. These factors should be considered as potential outcome predictors for patients with work-related low back pain. This study supported the neuromatrix theory of pain for patients with CLBP, as cognitive-evaluative factor contributed to pain perception, and cognitive-evaluative and sensory-discriminative factors uniquely contributed to an action program in response to chronic pain. Future research will determine if a predictive model consisting of fear-avoidance beliefs and temporal summation of evoked thermal pain has predictive validity for determining clinical outcome in rehabilitation or vocational settings.

Low-Cost Avoidance Behaviors are Resistant to Fear Extinction in Humans

PubMed Central

Vervliet, Bram; Indekeu, Ellen

2015-01-01

Elevated levels of fear and avoidance are core symptoms across the anxiety disorders. It has long been known that fear serves to motivate avoidance. Consequently, fear extinction has been the primary focus in pre-clinical anxiety research for decades, under the implicit assumption that removing the motivator of avoidance (fear) would automatically mitigate the avoidance behaviors as well. Although this assumption has intuitive appeal, it has received little scientific scrutiny. The scarce evidence from animal studies is mixed, while the assumption remains untested in humans. The current study applied an avoidance conditioning protocol in humans to investigate the effects of fear extinction on the persistence of low-cost avoidance. Online danger-safety ratings and skin conductance responses documented the dynamics of conditioned fear across avoidance and extinction phases. Anxiety- and avoidance-related questionnaires explored individual differences in rates of avoidance. Participants first learned to click a button during a predictive danger signal, in order to cancel an upcoming aversive electrical shock (avoidance conditioning). Next, fear extinction was induced by presenting the signal in the absence of shocks while button-clicks were prevented (by removing the button in Experiment 1, or by instructing not to click the button in Experiment 2). Most importantly, post-extinction availability of the button caused a significant return of avoidant button-clicks. In addition, trait-anxiety levels correlated positively with rates of avoidance during a predictive safety signal, and with the rate of pre- to post-extinction decrease during this signal. Fear measures gradually decreased during avoidance conditioning, as participants learned that button-clicks effectively canceled the shock. Preventing button-clicks elicited a sharp increase in fear, which subsequently extinguished. Fear remained low during avoidance testing, but danger-safety ratings increased again when button-clicks were subsequently prevented. Together, these results show that low-cost avoidance behaviors can persist following fear extinction and induce increased threat appraisal. On the other hand, fear extinction did reduce augmented rates of unnecessary avoidance during safety in trait-anxious individuals, and instruction-based response prevention was more effective than removal of response cues. More research is needed to characterize the conditions under which fear extinction might mitigate avoidance. PMID:26733837

Identifying patient fear-avoidance beliefs by physical therapists managing patients with low back pain.

PubMed

Calley, Darren Q; Jackson, Steven; Collins, Heather; George, Steven Z

2010-12-01

Cross-sectional. To evaluate the accuracy with which physical therapists identify fear-avoidance beliefs in patients with low back pain by comparing therapist ratings of perceived patient fear-avoidance to the Fear-Avoidance Beliefs Questionnaire (FABQ), Tampa Scale of Kinesiophobia 11-item (TSK-11), and Pain Catastrophizing Scale (PCS). To compare the concurrent validity of therapist ratings of perceived patient fear-avoidance and a 2-item questionnaire on fear of physical activity and harm, with clinical measures of fear-avoidance (FABQ, TSK-11, PCS), pain intensity as assessed with a numeric pain rating scale (NPRS), and disability as assessed with the Oswestry Disability Questionnaire (ODQ). The need to consider psychosocial factors for identifying patients at risk for disability and chronic low back pain has been well documented. Yet the ability of physical therapists to identify fear-avoidance beliefs using direct observation has not been studied. Eight physical therapists and 80 patients with low back pain from 3 physical therapy clinics participated in the study. Patients completed the FABQ, TSK-11, PCS, ODQ, NPRS, and a dichotomous 2-item fear-avoidance screening questionnaire. Following the initial evaluation, physical therapists rated perceived patient fear-avoidance on a 0-to-10 scale and recorded 2 influences on their ratings. Spearman correlation and independent t tests determined the level of association of therapist 0-to-10 ratings and 2-item screening with fear-avoidance and clinical measures. Therapist ratings of perceived patient fear-avoidance had fair to moderate interrater reliability (ICC2,1 = 0.663). Therapist ratings did not strongly correlate with FABQ or TSK-11 scores. Instead, they unexpectedly had stronger associations with ODQ and PCS scores. Both 2-item screening questions were associated with FABQ-physical activity scores, while the fear of physical activity question was also associated with FABQ-work, TSK-11, PCS, and ODQ scores. Therapists' ratings of perceived patient fear-avoidance were not associated with self-reported fear-avoidance scores, showing a potential disconnect between therapist judgments and commonly used fear-avoidance measures. Instead, therapist ratings had small but statistically significant correlations with pain catastrophizing and disability, findings that may support therapists' inability to discriminate fear-avoidance from these other factors. The 2-item screening questions based on fear of physical activity and harm showed potential to identify elevated FABQ physical activity scores. Differential diagnosis, level 2b.

Development and Validation of the Behavioral Avoidance Test-Back Pain (BAT-Back) for Patients With Chronic Low Back Pain.

PubMed

Holzapfel, Sebastian; Riecke, Jenny; Rief, Winfried; Schneider, Jessica; Glombiewski, Julia A

2016-11-01

Pain-related fear and avoidance of physical activities are central elements of the fear-avoidance model of musculoskeletal pain. Pain-related fear has typically been measured by self-report instruments. In this study, we developed and validated a Behavioral Avoidance Test (BAT) for chronic low back pain (CLBP) patients with the aim of assessing pain-related avoidance behavior by direct observation. The BAT-Back was administered to a group of CLBP patients (N=97) and pain-free controls (N=31). Furthermore, pain, pain-related fear, disability, catastrophizing, and avoidance behavior were measured using self-report instruments. Reliability was assessed with intraclass correlation coefficient and Cronbach α. Validity was assessed by examining correlation and regression analysis. The intraclass correlation coefficient for the BAT-Back avoidance score was r=0.76. Internal consistency was α=0.95. CLBP patients and controls differed significantly on BAT-Back avoidance scores as well as self-report measures. BAT-Back avoidance scores were significantly correlated with scores on each of the self-report measures (rs=0.27 to 0.54). They were not significantly correlated with general anxiety and depression, age, body mass index, and pain duration. The BAT-Back avoidance score was able to capture unique variance in disability after controlling for other variables (eg, pain intensity and pain-related fear). Results indicate that the BAT-Back is a reliable and valid measure of pain-related avoidance behavior. It may be useful for clinicians in tailoring treatments for chronic pain as well as an outcome measure for exposure treatments.

Testing conditions in shock-based contextual fear conditioning influence both the behavioral responses and the activation of circuits potentially involved in contextual avoidance.

PubMed

Viellard, Juliette; Baldo, Marcus Vinicius C; Canteras, Newton Sabino

2016-12-15

Previous studies from our group have shown that risk assessment behaviors are the primary contextual fear responses to predatory and social threats, whereas freezing is the main contextual fear response to physically harmful events. To test contextual fear responses to a predator or aggressive conspecific threat, we developed a model that involves placing the animal in an apparatus where it can avoid the threat-associated environment. Conversely, in studies that use shock-based fear conditioning, the animals are usually confined inside the conditioning chamber during the contextual fear test. In the present study, we tested shock-based contextual fear responses using two different behavioral testing conditions: confining the animal in the conditioning chamber or placing the animal in an apparatus with free access to the conditioning compartment. Our results showed that during the contextual fear test, the animals confined to the shock chamber exhibited significantly more freezing. In contrast, the animals that could avoid the conditioning compartment displayed almost no freezing and exhibited risk assessment responses (i.e., crouch-sniff and stretch postures) and burying behavior. In addition, the animals that were able to avoid the shock chamber had increased Fos expression in the juxtadorsomedial lateral hypothalamic area, the dorsomedial part of the dorsal premammillary nucleus and the lateral and dorsomedial parts of the periaqueductal gray, which are elements of a septo/hippocampal-hypothalamic-brainstem circuit that is putatively involved in mediating contextual avoidance. Overall, the present findings show that testing conditions significantly influence both behavioral responses and the activation of circuits involved in contextual avoidance. Copyright © 2016 Elsevier B.V. All rights reserved.

Modeling the Fear Effect in Predator-Prey Interactions with Adaptive Avoidance of Predators.

PubMed

Wang, Xiaoying; Zou, Xingfu

2017-06-01

Recent field experiments on vertebrates showed that the mere presence of a predator would cause a dramatic change of prey demography. Fear of predators increases the survival probability of prey, but leads to a cost of prey reproduction. Based on the experimental findings, we propose a predator-prey model with the cost of fear and adaptive avoidance of predators. Mathematical analyses show that the fear effect can interplay with maturation delay between juvenile prey and adult prey in determining the long-term population dynamics. A positive equilibrium may lose stability with an intermediate value of delay and regain stability if the delay is large. Numerical simulations show that both strong adaptation of adult prey and the large cost of fear have destabilizing effect while large population of predators has a stabilizing effect on the predator-prey interactions. Numerical simulations also imply that adult prey demonstrates stronger anti-predator behaviors if the population of predators is larger and shows weaker anti-predator behaviors if the cost of fear is larger.

The relationship between knowledge of pain neurophysiology and fear avoidance in people with chronic pain: A point in time, observational study.

PubMed

Fletcher, Claire; Bradnam, Lynley; Barr, Christopher

2016-05-01

Chronic pain is prevalent in the western world; however fear of pain often has a greater impact than the degree of initial injury. The aim of this study was to explore the relationship between knowledge of the neurophysiology of pain and fear avoidance in individuals diagnosed with chronic pain. Twenty-nine people with chronic musculoskeletal pain were recruited and completed questionnaires to determine their understanding of pain neurophysiology and the degree of their fear avoidance beliefs. There was an inverse relationship between knowledge of pain neurophysiology and the level of fear avoidance. Patients with higher pain knowledge reported less fear avoidance and lower perceived disability due to pain. There was no relationship with the educational level or compensable status for either variable. The findings suggest that fear avoidance is positively influenced by neurophysiology of pain education, so that a higher level of pain knowledge is associated with less activity-related fear. The clinical implication is that reducing fear avoidance/kinesiophobia using neurophysiology of pain education in people with chronic pain may provide an effective strategy to help manage fear avoidance and related disability in the chronic pain population in order to improve treatment outcomes.

The Role of Muscarinic and Nicotinic Cholinergic Neurotransmission in Aversive Conditioning: Comparing Pavlovian Fear Conditioning and Inhibitory Avoidance

ERIC Educational Resources Information Center

Tinsley, Matthew R.; Quinn, Jennifer J.; Fanselow, Michael S.

2004-01-01

Aversive conditioning is an ideal model for studying cholinergic effects on the processes of learning and memory for several reasons. First, deficits produced by selective lesions of the anatomical structures shown to be critical for Pavlovian fear conditioning and inhibitory avoidance (such as the amygdala and hippocampus) resemble those deficits…

Psychosocial job conditions, fear avoidance beliefs and expected return to work following acute coronary syndrome: a cross-sectional study of fear-avoidance as a potential mediator.

PubMed

Söderberg, Mia; Rosengren, Annika; Gustavsson, Sara; Schiöler, Linus; Härenstam, Annika; Torén, Kjell

2015-12-21

Despite improvements in treatment, acute coronary syndrome remains a substantial cause for prolonged sick absences and premature retirement. Knowledge regarding what benefits return to work is limited, especially the effect of psychological processes and psychosocial work factors. The purposes of this cross-sectional study were two-fold: to examine associations between adverse psychosocial job conditions and fear-avoidance beliefs towards work, and to determine whether such beliefs mediated the relationship between work conditions and expected return to work in acute coronary syndrome survivors. Study inclusion criteria: acute myocardial infarction or unstable angina diagnosis, below 65 years of age, being a resident in the West county of Sweden and currently working. In all, 509 individuals (21.8 % women) accepted study participation and for whom all data of study interest were available for analysis. Psychosocial work variables; job demand-control and effort-reward imbalance, were assessed with standard questionnaire batteries. Linear regression models were used to investigate relationships between psychosocial factors and fear-avoidance, and to evaluate mediator effects for fear-avoidance. Both total sample and gender stratified analyses were calculated. Fear-avoidance beliefs about work were associated to psychosocial job environments characterized by high strain (β 1.4; CI 1.2-1.6), active and passive work and high effort-reward imbalance (β 0.6; CI 0.5-0.7). Further, such beliefs also mediated the relationship between adverse work conditions and expected time for return to work. However, these results were only observed in total sample analyses or among or male participants. For women only high strain was linked to fear-avoidance, and these relationships became non-significant when entering chosen confounders. This cross-sectional study showed that acute coronary syndrome survivors, who laboured under adverse psychosocial work conditions, held fear-avoidance beliefs towards their workplace. Furthermore, these beliefs mediated the relationships between - high strained or high effort-reward imbalanced work - and expected return to work. However, mentioned results were primarily found among men, which could results from few female study participants or gender differences in return to work mechanisms. Still, an earlier return to work might be promoted by interventions focusing on improved psychosocial work conditions and cognitive behavioural therapy targeting fear-avoidance beliefs.

The influence of acute stress on the regulation of conditioned fear

PubMed Central

Raio, Candace M.; Phelps, Elizabeth A.

2014-01-01

Fear learning and regulation is a prominent model for describing the pathogenesis of anxiety disorders and stress-related psychopathology. Fear expression can be modulated using a number of regulatory strategies, including extinction, cognitive emotion regulation, avoidance strategies and reconsolidation. In this review, we examine research investigating the effects of acute stress and stress hormones on these regulatory techniques. We focus on what is known about the impact of stress on the ability to flexibly regulate fear responses that are acquired through Pavlovian fear conditioning. Our primary aim is to explore the impact of stress on fear regulation in humans. Given this, we focus on techniques where stress has been linked to alterations of fear regulation in humans (extinction and emotion regulation), and briefly discuss other techniques (avoidance and reconsolidation) where the impact of stress or stress hormones have been mainly explored in animal models. These investigations reveal that acute stress may impair the persistent inhibition of fear, presumably by altering prefrontal cortex function. Characterizing the effects of stress on fear regulation is critical for understanding the boundaries within which existing regulation strategies are viable in everyday life and can better inform treatment options for those who suffer from anxiety and stress-related psychopathology. PMID:25530986

LMFAO! Humor as a Response to Fear: Decomposing Fear Control within the Extended Parallel Process Model

PubMed Central

Abril, Eulàlia P.; Szczypka, Glen; Emery, Sherry L.

2017-01-01

This study seeks to analyze fear control responses to the 2012 Tips from Former Smokers campaign using the Extended Parallel Process Model (EPPM). The goal is to examine the occurrence of ancillary fear control responses, like humor. In order to explore individuals’ responses in an organic setting, we use Twitter data—tweets—collected via the Firehose. Content analysis of relevant fear control tweets (N = 14,281) validated the existence of boomerang responses within the EPPM: denial, defensive avoidance, and reactance. More importantly, results showed that humor tweets were not only a significant occurrence but constituted the majority of fear control responses. PMID:29527092

Screening for elevated levels of fear-avoidance beliefs regarding work or physical activities in people receiving outpatient therapy.

PubMed

Hart, Dennis L; Werneke, Mark W; George, Steven Z; Matheson, James W; Wang, Ying-Chih; Cook, Karon F; Mioduski, Jerome E; Choi, Seung W

2009-08-01

Screening people for elevated levels of fear-avoidance beliefs is uncommon, but elevated levels of fear could worsen outcomes. Developing short screening tools might reduce the data collection burden and facilitate screening, which could prompt further testing or management strategy modifications to improve outcomes. The purpose of this study was to develop efficient yet accurate screening methods for identifying elevated levels of fear-avoidance beliefs regarding work or physical activities in people receiving outpatient rehabilitation. A secondary analysis of data collected prospectively from people with a variety of common neuromusculoskeletal diagnoses was conducted. Intake Fear-Avoidance Beliefs Questionnaire (FABQ) data were collected from 17,804 people who had common neuromusculoskeletal conditions and were receiving outpatient rehabilitation in 121 clinics in 26 states (in the United States). Item response theory (IRT) methods were used to analyze the FABQ data, with particular emphasis on differential item functioning among clinically logical groups of subjects, and to identify screening items. The accuracy of screening items for identifying subjects with elevated levels of fear was assessed with receiver operating characteristic analyses. Three items for fear of physical activities and 10 items for fear of work activities represented unidimensional scales with adequate IRT model fit. Differential item functioning was negligible for variables known to affect functional status outcomes: sex, age, symptom acuity, surgical history, pain intensity, condition severity, and impairment. Items that provided maximum information at the median for the FABQ scales were selected as screening items to dichotomize subjects by high versus low levels of fear. The accuracy of the screening items was supported for both scales. This study represents a retrospective analysis, which should be replicated using prospective designs. Future prospective studies should assess the reliability and validity of using one FABQ item to screen people for high levels of fear-avoidance beliefs. The lack of differential item functioning in the FABQ scales in the sample tested in this study suggested that FABQ screening could be useful in routine clinical practice and allowed the development of single-item screening for fear-avoidance beliefs that accurately identified subjects with elevated levels of fear. Because screening was accurate and efficient, single IRT-based FABQ screening items are recommended to facilitate improved evaluation and care of heterogeneous populations of people receiving outpatient rehabilitation.

Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice.

PubMed

Nijs, Jo; Roussel, Nathalie; Van Oosterwijck, Jessica; De Kooning, Margot; Ickmans, Kelly; Struyf, Filip; Meeus, Mira; Lundberg, Mari

2013-08-01

Severe exacerbation of symptoms following physical activity is characteristic for chronic-fatigue syndrome (CFS) and fibromyalgia (FM). These exacerbations make it understandable for people with CFS and FM to develop fear of performing body movement or physical activity and consequently avoidance behaviour toward physical activity. The aims of this article were to review what measures are available for measuring fear of movement and avoidance behaviour, the prevalence fear of movement and avoidance behaviour toward physical activity and the therapeutic options with fear of movement and avoidance behaviour toward physical activity in patients with CFS and FM. The review revealed that fear of movement and avoidance behaviour toward physical activity is highly prevalent in both the CFS and FM population, and it is related to various clinical characteristics of CFS and FM, including symptom severity and self-reported quality of life and disability. It appears to be crucial for treatment (success) to identify CFS and FM patients displaying fear of movement and avoidance behaviour toward physical activity. Individually tailored cognitive behavioural therapy plus exercise training, depending on the patient's classification as avoiding or persisting, appears to be the most promising strategy for treating fear of movement and avoidance behaviour toward physical activity in patients with CFS and FM.

Vicarious Learning and Reduction of Fear in Children via Adult and Child Models.

PubMed

Dunne, Güler; Askew, Chris

2017-06-01

Children can learn to fear stimuli vicariously, by observing adults' or peers' responses to them. Given that much of school-age children's time is typically spent with their peers, it is important to establish whether fear learning from peers is as effective or robust as learning from adults, and also whether peers can be successful positive models for reducing fear. During a vicarious fear learning procedure, children (6 to 10 years; N = 60) were shown images of novel animals together with images of adult or peer faces expressing fear. Later they saw their fear-paired animal again together with positive emotional adult or peer faces. Children's fear beliefs and avoidance for the animals increased following vicarious fear learning and decreased following positive vicarious counterconditioning. There was little evidence of differences in learning from adults and peers, demonstrating that for this age group peer models are effective models for both fear acquisition and reduction. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Graded activity for workers with low back pain: who benefits most and how does it work?

PubMed

Staal, J Bart; Hlobil, Hynek; Köke, Albère J A; Twisk, Jos W R; Smid, Tjabe; van Mechelen, Willem

2008-05-15

To identify subgroups of workers absent from work due to low back pain who are more or less likely to return to work earlier as a result of a graded activity intervention, and to investigate whether this intervention is effective in reducing pain-related fears and if so, whether these reductions in pain-related fears mediate return to work. A subgroup analysis was conducted on data from a previous randomized controlled trial of 134 Dutch airline workers, which found that a behaviorally-oriented graded activity intervention was more effective than usual care in stimulating return to work. The subgroup analyses added interaction terms to a Cox regression model that described the relationship between treatment allocation and return to work over 12 months of followup. Furthermore, we studied the effects of graded activity on pain-related fears and added variables indicating a reduction in pain-related fears to the model in order to investigate their influence on return to work. Statistically significant interactions were found for disability, fear-avoidance beliefs about physical activity, and fear-avoidance beliefs about work. No indication was found that the reduction in pain-related fears in the graded activity group mediated more favorable return-to-work results in this group. Workers who perceive their disability to be moderate and workers with moderate scores for fear-avoidance beliefs return to work more rapidly as a result of the graded activity intervention than workers with higher scores. The return to work of workers receiving the graded activity intervention is possibly independent from the reductions in pain-related fears caused by this intervention.

Fear of (re)injury and return to work following compensable injury: qualitative insights from key stakeholders in Victoria, Australia.

PubMed

Bunzli, Samantha; Singh, Nabita; Mazza, Danielle; Collie, Alex; Kosny, Agnieszka; Ruseckaite, Rasa; Brijnath, Bianca

2017-04-11

Return to work (RTW) is important for recovery post-injury. Fear of (re)injury is a strong predictor of delayed RTW, and therefore much attention has been given to addressing injured workers' fear beliefs. However, RTW is a socially-negotiated process and it may be important to consider the wider social context of the injured worker, including the beliefs of the key people involved in their RTW journey. This paper involves data collected as part of a wider study in which semi-structured interviews explored RTW from the perspectives of 93 key stakeholders: injured workers, GPs, employers and insurance case managers in Victoria, Australia. Inductive analysis of interview transcripts identified fear of (re)injury as a salient theme across all stakeholder groups. This presented an opportunity to analyse how the wider social context of the injured worker may influence fear and avoidance behaviour. Two co-authors performed inductive analysis of the theme 'fear of (re)injury'. Codes identified in the data were grouped into five categories. Between and within category analysis revealed three themes describing the contextual factors that may influence fear avoidance and RTW behaviour. Theme one described how injured workers engaged in a process of weighing up the risk of (re)injury in the workplace against the perceived benefits of RTW. Theme two described how workplace factors could influence an injured workers' perception of the risk of (re)injury in the workplace, including confidence that the source of the injury had been addressed, the availability and suitability of alternative duties. Theme three described other stakeholders' reluctance to accept injured workers back at work because of the fear that they might reinjure themselves. Our findings illustrate the need for a contextualised perspective of fear avoidance and RTW behaviour that includes the beliefs of other important people surrounding the injured worker (e.g. employers, family members, GPs). Existing models of health behaviour such as The Health Beliefs Model may provide useful frameworks for interventions targeting the affective, cognitive, social, organisational and policy factors that can influence fear avoidance or facilitate RTW following injury.

The structure of vulnerabilities for social anxiety disorder.

PubMed

Rodebaugh, Thomas L; Levinson, Cheri A; Langer, Julia K; Weeks, Justin W; Heimberg, Richard G; Brown, Patrick J; Menatti, Andrew R; Schneier, Franklin R; Blanco, Carlos; Liebowitz, Michael R

2017-04-01

Social anxiety disorder symptoms are generally proposed to be related to broad temperamental vulnerabilities (e.g., a low level of approach and high level of avoidance temperament), specific psychological vulnerabilities (e.g., fears of negative and positive evaluation), and additional disorders (e.g., major depressive disorder). However, existing tests of such a model have either not considered depressive symptoms or relied on samples of undergraduates. We examined these and related questions via a latent variable model in a large dataset (N=2253) that combined participants across a variety of studies. The model had adequate fit in the whole sample, and good fit in a subsample in which more participants completed the depression measure. The model indicated that low level of approach and high level of avoidance temperament contributed to fears of evaluation and social anxiety symptoms, and that fears of evaluation additionally contributed independently to social anxiety symptoms. The relationship between social anxiety and depressive symptoms was entirely accounted for by these vulnerabilities: Depressive symptoms were only predicted by avoidance temperament. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Optimism Moderates the Influence of Pain Catastrophizing on Shoulder Pain Outcome: A Longitudinal Analysis.

PubMed

Coronado, Rogelio A; Simon, Corey B; Lentz, Trevor A; Gay, Charles W; Mackie, Lauren N; George, Steven Z

2017-01-01

Study Design Secondary analysis of prospectively collected data. Background An abundance of evidence has highlighted the influence of pain catastrophizing and fear avoidance on clinical outcomes. Less is known about the interaction of positive psychological resources with these pain-associated distress factors. Objective To assess whether optimism moderates the influence of pain catastrophizing and fear avoidance on 3-month clinical outcomes in patients with shoulder pain. Methods Data from 63 individuals with shoulder pain (mean ± SD age, 38.8 ± 14.9 years; 30 female) were examined. Demographic, psychological, and clinical characteristics were obtained at baseline. Validated measures were used to assess optimism (Life Orientation Test-Revised), pain catastrophizing (Pain Catastrophizing Scale), fear avoidance (Fear-Avoidance Beliefs Questionnaire physical activity subscale), shoulder pain intensity (Brief Pain Inventory), and shoulder function (Pennsylvania Shoulder Score function subscale). Shoulder pain and function were reassessed at 3 months. Regression models assessed the influence of (1) pain catastrophizing and optimism and (2) fear avoidance and optimism. The final multivariable models controlled for factors of age, sex, education, and baseline scores, and included 3-month pain intensity and function as separate dependent variables. Results Shoulder pain (mean difference, -1.6; 95% confidence interval [CI]: -2.1, -1.2) and function (mean difference, 2.4; 95% CI: 0.3, 4.4) improved over 3 months. In multivariable analyses, there was an interaction between pain catastrophizing and optimism (β = 0.19; 95% CI: 0.02, 0.35) for predicting 3-month shoulder function (F = 16.8, R 2 = 0.69, P<.001), but not pain (P = .213). Further examination of the interaction with the Johnson-Neyman technique showed that higher levels of optimism lessened the influence of pain catastrophizing on function. There was no evidence of significant moderation of fear-avoidance beliefs for 3-month shoulder pain (P = .090) or function (P = .092). Conclusion Optimism decreased the negative influence of pain catastrophizing on shoulder function, but not pain intensity. Optimism did not alter the influence of fear-avoidance beliefs on these outcomes. Level of Evidence Prognosis, level 2b. J Orthop Sports Phys Ther 2017;47(1):21-30. Epub 5 Nov 2016. doi:10.2519/jospt.2017.7068.

High fear of intra-oral injections: prevalence and relationship to dental fear and dental avoidance among 10- to 16-yr-old children.

PubMed

Berge, Karin G; Agdal, Maren L; Vika, Margrethe; Skeie, Marit S

2016-12-01

The present study aimed to: (i) estimate the prevalence of self-reported high fear of intra-oral injections, high blood-injury fear, and injection fear; (ii) explore the overlap between high fear of intra-oral injections and high fear of dental treatment; and (iii) evaluate the possible consequence of high fear of intra-oral injections in terms of avoidance of dental care. The sample included 1,441 subjects, 10- to 16-yr of age, attending elementary schools in a county of Norway. Data were collected using questionnaires that were completed in classrooms. The survey instruments used were the Intra-Oral Injection Fear-scale, the Children's Fear Survey Schedule-Dental Subscale, the Injection Phobia scale for children, and the Mutilation Questionnaire for children. In total, 13.9% of the children reported high intra-oral injection fear. A strong association was found between fear of intra-oral injections and dental fear. When an intra-oral injection was needed, 10.6% would avoid dental treatment. In multiple regression analysis, high intra-oral injection fear was found to be associated with avoidance of dental treatment (OR = 6.52; 95% CI: 3.99-10.67). It was concluded that high fear of intra-oral injections was prevalent and might lead to avoidance of necessary dental treatment. Hence, intra-oral injection fear should be addressed before treatment of dental fear. © 2016 Eur J Oral Sci.

Passive Avoidance Is Linked to Impaired Fear Extinction in Humans

ERIC Educational Resources Information Center

Cornwell, Brian R.; Overstreet, Cassie; Krimsky, Marissa; Grillon, Christian

2013-01-01

Conventional wisdom dictates we must face our fears to conquer them. This idea is embodied in exposure-based treatments for anxiety disorders, where the intent of exposure is to reverse a history of avoidant behavior that is thought to fuel a patient's irrational fears. We tested in humans the relationship between fear and avoidance by combining…

Social and monetary incentives counteract fear-driven avoidance: Evidence from approach-avoidance decisions.

PubMed

Pittig, Andre; Hengen, Kristina; Bublatzky, Florian; Alpers, Georg W

2018-04-22

The reduction of avoidance behavior is a central target in the treatment of anxiety disorders, but it has rarely been studied how approach of fear-relevant stimuli may be initiated. In two studies, the impact of hypothetical monetary and symbolic social incentives on approach-avoidance behavior was examined. In Study 1, individuals high or low on fear of spiders (N = 84) could choose to approach a fear-relevant versus a neutral stimulus, which were equally rewarded. In a subsequent micro-intervention, approaching the fear-relevant stimulus was differentially rewarded either by monetary or social incentives. In Study 2 (N = 76), initial incentives for approach were discontinued to investigate the stability of approach. Hypothetical monetary and symbolic social incentives reduced or eliminated initial avoidance, even in highly fearful individuals. Approach resulted in a decrease of self-reported aversiveness towards the fear-relevant stimulus. However, even after successful approach, fearful individuals showed significant avoidance behavior when incentives for approach were discontinued. Future research should investigate the long-term effects of prolonged approach incentives on multiple levels of fear (e.g., self-report, behavioral, physiological). It should also be tested if such an intervention actually improves compliance with exposure based interventions. The present findings highlight that incentives are useful to initiate initial approach towards a feared stimulus. Although incentive-based approach may neither fully eliminate avoidance nor negative feelings towards the feared stimulus, such operant interventions may set the stage for more extensive extinction training. Copyright © 2018 Elsevier Ltd. All rights reserved.

Do peritraumatic emotions differentially predict PTSD symptom clusters? Initial evidence for emotion specificity.

PubMed

Dewey, Daniel; Schuldberg, David; Madathil, Renee

2014-08-01

This study investigated whether specific peritraumatic emotions differentially predict PTSD symptom clusters in individuals who have experienced stressful life events. Hypotheses were developed based on the SPAARS model of PTSD. It was predicted that the peritraumatic emotions of anger, disgust, guilt, and fear would significantly predict re-experiencing and avoidance symptoms, while only fear would predict hyperarousal. Undergraduate students (N = 144) participated in this study by completing a packet of self-report questionnaires. Multiple regression analyses were conducted with PCL-S symptom cluster scores as dependent variables and peritraumatic fear, guilt, anger, shame, and disgust as predictor variables. As hypothesized, peritraumatic anger, guilt, and fear all significantly predicted re-experiencing. However, only fear predicted avoidance, and anger significantly predicted hyperarousal. Results are discussed in relation to the theoretical role of emotions in the etiology of PTSD following the experience of a stressful life event.

Increased levels of conditioned fear and avoidance behavior coincide with changes in phosphorylation of the protein kinase B (AKT) within the amygdala in a mouse model of extremes in trait anxiety.

PubMed

Yen, Yi-Chun; Mauch, Christoph P; Dahlhoff, Maik; Micale, Vincenzo; Bunck, Mirjam; Sartori, Simone B; Singewald, Nicolas; Landgraf, Rainer; Wotjak, Carsten T

2012-07-01

Patients diagnosed for anxiety disorders often display faster acquisition and slower extinction of learned fear. To gain further insights into the mechanisms underlying these phenomenona, we studied conditioned fear in mice originating form a bi-directional selective breeding approach, which is based on elevated plus-maze behavior and results in CD1-derived high (HAB), normal (NAB), and low (LAB) anxiety-related behavior mice. HAB mice displayed pronounced cued-conditioned fear compared to NAB/CD1 and LAB mice that coincided with increased phosphorylation of the protein kinase B (AKT) in the basolateral amygdala 45 min after conditioning. No similar changes were observed after non-associative immediate shock presentations. Fear extinction of recent but not older fear memories was preserved. However, HAB mice were more prone to relapse of conditioned fear with the passage of time. HAB mice also displayed higher levels of contextual fear compared to NAB and LAB mice and exaggerated avoidance following step-down avoidance training. Interestingly, HAB mice showed lower and LAB mice higher levels of acoustic startle responses compared to NAB controls. The increase in arousal observed in LAB mice coincided with the general absence of conditioned freezing. Taken together, our results suggest that the genetic predisposition to high anxiety-related behavior may increase the risk of forming traumatic memories, phobic-like fear and avoidance behavior following aversive encounters, with a clear bias towards passive coping styles. In contrast, genetic predisposition to low anxiety-related and high risk-taking behavior seems to be associated with an increase in active coping styles. Our data imply changes in AKT phosphorylation as a therapeutic target for the prevention of exaggerated fear memories. Copyright © 2012 Elsevier Inc. All rights reserved.

The effects of verbal information and approach-avoidance training on children's fear-related responses

PubMed Central

Lester, Kathryn J.; Lisk, Stephen C.; Mikita, Nina; Mitchell, Sophie; Huijding, Jorg; Rinck, Mike; Field, Andy P.

2015-01-01

Background and objectives This study examined the effects of verbal information and approach-avoidance training on fear-related cognitive and behavioural responses about novel animals. Methods One hundred and sixty children (7–11 years) were randomly allocated to receive: a) positive verbal information about one novel animal and threat information about a second novel animal (verbal information condition); b) approach-avoidance training in which they repeatedly pushed away (avoid) or pulled closer (approach) pictures of the animals (approach-avoidance training), c) a combined condition in which verbal information was given prior to approach-avoidance training (verbal information + approach-avoidance training) and d) a combined condition in which approach-avoidance training was given prior to verbal information (approach-avoidance training + verbal information). Results Threat and positive information significantly increased and decreased fear beliefs and avoidance behaviour respectively. Approach-avoidance training was successful in training the desired behavioural responses but had limited effects on fear-related responses. Verbal information and both combined conditions resulted in significantly larger effects than approach-avoidance training. We found no evidence for an additive effect of these pathways. Limitations This study used a non-clinical sample and focused on novel animals rather than animals about which children already had experience or established fears. The study also compared positive information/approach with threat information/avoid training, limiting specific conclusions regarding the independent effects of these conditions. Conclusions The present study finds little evidence in support of a possible causal role for behavioural response training in the aetiology of childhood fear. However, the provision of verbal information appears to be an important pathway involved in the aetiology of childhood fear. PMID:25698069

The effects of verbal information and approach-avoidance training on children's fear-related responses.

PubMed

Lester, Kathryn J; Lisk, Stephen C; Mikita, Nina; Mitchell, Sophie; Huijding, Jorg; Rinck, Mike; Field, Andy P

2015-09-01

This study examined the effects of verbal information and approach-avoidance training on fear-related cognitive and behavioural responses about novel animals. One hundred and sixty children (7-11 years) were randomly allocated to receive: a) positive verbal information about one novel animal and threat information about a second novel animal (verbal information condition); b) approach-avoidance training in which they repeatedly pushed away (avoid) or pulled closer (approach) pictures of the animals (approach-avoidance training), c) a combined condition in which verbal information was given prior to approach-avoidance training (verbal information + approach-avoidance training) and d) a combined condition in which approach-avoidance training was given prior to verbal information (approach-avoidance training + verbal information). Threat and positive information significantly increased and decreased fear beliefs and avoidance behaviour respectively. Approach-avoidance training was successful in training the desired behavioural responses but had limited effects on fear-related responses. Verbal information and both combined conditions resulted in significantly larger effects than approach-avoidance training. We found no evidence for an additive effect of these pathways. This study used a non-clinical sample and focused on novel animals rather than animals about which children already had experience or established fears. The study also compared positive information/approach with threat information/avoid training, limiting specific conclusions regarding the independent effects of these conditions. The present study finds little evidence in support of a possible causal role for behavioural response training in the aetiology of childhood fear. However, the provision of verbal information appears to be an important pathway involved in the aetiology of childhood fear. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Posttraumatic stress symptoms and the diathesis-stress model of chronic pain and disability in patients undergoing major surgery.

PubMed

Martin, Andrea L; Halket, Eileen; Asmundson, Gordon J G; Flora, David B; Katz, Joel

2010-01-01

To (1) use structural equation modeling (SEM) to examine relationships proposed in Turk's diathesis-stress model of chronic pain and disability as well as (2) investigate what role, if any, posttraumatic stress symptoms (PTSS) play in predicting pain disability, relative to some of the other factors in the model. The study sample consisted of 208 patients scheduled for general surgery, 21 to 60 years of age (mean age=47.18 y, SD=9.72 y), who reported experiencing persistent pain for an average of 5.56 years (SD=7.90 y). At their preadmission hospital visit, patients completed the Anxiety Sensitivity Index, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Disability Index, posttraumatic stress disorder Checklist, and rated the average intensity of their pain (0 to 10 numeric rating scale). SEM was used to test a model of chronic pain disability and to explore potential relationships between PTSS and factors in the diathesis-stress model. SEM results provided support for a model in which anxiety sensitivity predicted fear of pain and catastrophizing, fear of pain predicted escape/avoidance, and escape/avoidance predicted pain disability. Results also provided support for a feedback loop between disability and fear of pain. SEM analyses provided preliminary support for the inclusion of PTSS in the diathesis-stress model, with PTSS accounting for a significant proportion of the variance in pain disability. Results provide empirical support for aspects of Turk's diathesis-stress model in a sample of patients with persistent pain. Findings also offer preliminary support for the role of PTSS in fear-avoidance models of chronic pain.

A Model of Parental Achievement-Oriented Psychological Control in Academically Gifted Students

ERIC Educational Resources Information Center

Garn, Alex C.; Jolly, Jennifer L.

2015-01-01

This study investigated achievement-oriented parent socialization as it pertains to school avoidance in a sample of gifted students. A serial mediation model examining relationships among parental achievement-oriented psychological control (APC), fear of academic failure, academic amotivation, and school avoidance was tested. The sample included…

Emotion avoidance and fear bradycardia in patients with borderline personality disorder and healthy controls.

PubMed

Stoffels, Malou; Nijs, Maurits; Spinhoven, Philip; Mesbah, Rahele; Hagenaars, Muriel A

2017-12-01

Exaggerated emotional reactivity is supposed to be essential in the etiology of borderline personality disorder (BPD). More specifically, models of defensive behavior would predict reduced freezing behavior -indicated by fear bradycardia-in response to threat. This study examined automatic fear bradycardia responses in BPD versus healthy controls and the role of emotion dysregulation, more specifically tendencies to avoid emotions. Patients with BPD (n = 23) and healthy controls (n = 18) completed questionnaires and then watched neutral, pleasant and unpleasant pictures while heart rate was assessed. Emotion avoidance interacted with group: it was associated with distinct autonomic responses in healthy controls but not in BPD patients. Controls with lower emotion avoidance tendencies showed bradycardia in response to unpleasant pictures, while controls with higher emotion avoidance tendencies did not. BPD patients showed no bradycardia, irrespective of their emotion avoidance tendencies. This study is limited by a small sample size. Comorbidity or medication intake were not controlled for. The results may suggest impaired automatic defense responses in BPD. Further understanding of the regulation of distress and defense responses might improve BPD treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Dementia attitudes and help-seeking intentions: an investigation of responses to two scenarios of an experience of the early signs of dementia.

PubMed

Phillipson, Lyn; Magee, Christopher; Jones, Sandra; Reis, Samantha; Skladzien, Ellen

2015-01-01

To investigate associations between dementia-attitudes and help-seeking intentions. An online survey of 611 Australian adults (45-60 years) assessed dementia-related attitudes and help-seeking intentions in response to two scenarios of an experience of early dementia: for themselves (Scenario 1); and for a significant other (proxy help-seeking) (Scenario 2). Logistic regression models examined the relationship between four dementia-related attitudes (labelled Personal Avoidance, Fear of Labelling, Fear of Discrimination and Person Centredness) and help-seeking intentions. Most participants indicated they would seek help from a general practitioner (GP) for themselves (82.2%) or for a proxy (78.7%) in response to the scenarios. Whilst only 7.2% indicated they would seek help from no-one, 21.3% would delay seeking help. In response to Scenario 1, Personal Avoidance and Fear of Labelling were associated with intentions to delay help-seeking. Fear of both Labelling and Discrimination were associated with intentions to seek help from no-one. In response to Scenario 2, Personal Avoidance was associated with intentions to delay proxy help-seeking and a reduced likelihood of seeking help by phone or and with Fear of Discrimination, via a GP. Fear of Labelling was also associated with an intention to delay proxy help-seeking. Efforts to improve help-seeking for dementia should address attitudes relating to stigma including negative labelling and a desire for the avoidance of people with dementia. Fears relating to discrimination indicate a need to build public confidence regarding the capacity of the health and workforce sectors to support people with dementia ethically and appropriately.

An overview of translationally informed treatments for PTSD: animal models of Pavlovian fear conditioning to human clinical trials

PubMed Central

Bowers, Mallory E.; Ressler, Kerry J.

2015-01-01

Posttraumatic stress disorder (PTSD) manifests after exposure to a traumatic event and is characterized by avoidance/numbing, intrusive symptoms and flashbacks, mood and cognitive disruptions, and hyperarousal/reactivity symptoms. These symptoms reflect dysregulation of the fear system likely caused by poor fear inhibition/extinction, increased generalization, and/or enhanced consolidation or acquisition of fear. These phenotypes can be modeled in animal subjects using Pavlovian fear conditioning, allowing investigation of the underlying neurobiology of normative and pathological fear. Pre-clinical studies reveal a number of neurotransmitter systems and circuits critical for aversive learning and memory, which have informed the development of therapies used in human clinical trials. In this review, we discuss the evidence for a number of established and emerging pharmacotherapies and device-based treatments for PTSD that have been developed via a bench to bedside translational model. PMID:26238379

Relationship between fear avoidance beliefs and burnout syndrome in patients with lumbar disc herniation.

PubMed

Taspinar, Ferruh; Taspinar, Betul; Ozkan, Yasemin; Afsar, Emrah; Gul, Canan; Durmaz, Elif Dilara

2016-06-17

Lumbar disc herniation leads to disability by restricting of patients' lives and reducing their quality of life. This situation causes a decrease in motivation of patients by triggering depressive mood. Therefore, the aim of the study was investigation of correlation between fear avoidance beliefs and burnout syndrome in patients with lumbar disc herniation. Totally forty-seven patients (24 male and 23 female patients) diagnosed lumbar disc herniation was included in this study. Maslach II Burnout Inventory (MBI) and Fear Avoidance Beliefs Questionnaire (FABQ) for determining of levels of burnout and fear avoidance level were used, respectively. It was observed that MBI and FABQ scores of the patients were 50.78 ± 10.07 and 36.61 ± 13.91, respectively. Moderate level correlation was found between FABQ and MBI total scores (r= 0.49, p= 0.00). Fear avoidance beliefs of patients with chronic back pain can affect level of burnout syndrome. Therefore, symptoms of burnout syndrome and fear avoidance beliefs of patients should be considered in evaluation and treatment process.

Addition of posttraumatic stress and sensory hypersensitivity more accurately estimates disability and pain than fear avoidance measures alone after whiplash injury.

PubMed

Pedler, Ashley; Kamper, Steven J; Sterling, Michele

2016-08-01

The fear avoidance model (FAM) has been proposed to explain the development of chronic disability in a variety of conditions including whiplash-associated disorders (WADs). The FAM does not account for symptoms of posttraumatic stress and sensory hypersensitivity, which are associated with poor recovery from whiplash injury. The aim of this study was to explore a model for the maintenance of pain and related disability in people with WAD including symptoms of PTSD, sensory hypersensitivity, and FAM components. The relationship between individual components in the model and disability and how these relationships changed over the first 12 weeks after injury were investigated. We performed a longitudinal study of 103 (74 female) patients with WAD. Measures of pain intensity, cold and mechanical pain thresholds, symptoms of posttraumatic stress, pain catastrophising, kinesiophobia, and fear of cervical spine movement were collected within 6 weeks of injury and at 12 weeks after injury. Mixed-model analysis using Neck Disability Index (NDI) scores and average 24-hour pain intensity as the dependent variables revealed that overall model fit was greatest when measures of fear of movement, posttraumatic stress, and sensory hypersensitivity were included. The interactive effects of time with catastrophising and time with fear of activity of the cervical spine were also included in the best model for disability. These results provide preliminary support for the addition of neurobiological and stress system components to the FAM to explain poor outcome in patients with WAD.

Do preoperative fear avoidance model factors predict outcomes after lumbar disc herniation surgery? A systematic review.

PubMed

Alodaibi, Faris A; Minick, Kate I; Fritz, Julie M

2013-11-18

Lumbar disc herniation (LDH) surgery is usually recommended when conservative treatments fail to manage patients' symptoms. However, many patients undergoing LDH surgery continue to report pain and disability. Preoperative psychological factors have shown to be predictive for postoperative outcomes. Our aim was to systematically review studies that prospectively examined the prognostic value of factors in the Fear Avoidance Model (FAM), including back pain, leg pain, catastrophizing, anxiety, fear-avoidance, depression, physical activity and disability, to predict postoperative outcomes in patients undergoing LDH surgery. We performed a systematic literature review of prospective studies that measured any FAM factors preoperatively to predict postoperative outcomes for patients undergoing LDH surgery. Our search databases included PubMed, CINAHL, and PsycINFO. We assessed the quality of each included study using a certain quality assessment list. Degree of agreement between reviewers on quality assessment was examined. Results related to FAM factors in the included studies were summarized. Thirteen prospective studies met our inclusion criteria. Most studies were considered high quality. Heterogeneity was present between the included studies in many aspects. The most common FAM factors examinered were baseline pain, disability and depression. In, general, depression, fear-avoidance behaviors, passive pain coping, and anxiety FAM factors appeared to have negative influence on LDH surgical outcome. Baseline back pain and leg pain appeared to have differing prognostic value on LDH surgical outcomes. FAM factors seem to influence LDH surgical outcomes. Patients with high levels of depression, anxiety and fear-avoidance behaviors are more likely to have poor outcomes following LDH surgery. Conversely, high levels of leg pain, but not back pain seem to be predictor for favorable LDH surgery outcome. More research is needed to determine the exact role of FAM factors on LDH surgical outcome and the value for screening for these factors.

The Relation between Youth Fear and Avoidance of Crime in School and Academic Experiences

ERIC Educational Resources Information Center

Barrett, Kimberly L.; Jennings, Wesley G.; Lynch, Michael J.

2012-01-01

Despite decades of research analyzing fear of crime among adults, little is known about youth fear of crime in general and youth fear of crime in school, specifically. Moreover, among existing studies most emphasize causes of fear, with little discussion of avoidance or the academic consequences of these feelings and behaviors in school. This…

Low Back Pain Subgroups using Fear-Avoidance Model Measures: Results of a Cluster Analysis

PubMed Central

Beneciuk, Jason M.; Robinson, Michael E.; George, Steven Z.

2012-01-01

Objectives The purpose of this secondary analysis was to test the hypothesis that an empirically derived psychological subgrouping scheme based on multiple Fear-Avoidance Model (FAM) constructs would provide additional capabilities for clinical outcomes in comparison to a single FAM construct. Methods Patients (n = 108) with acute or sub-acute low back pain (LBP) enrolled in a clinical trial comparing behavioral physical therapy interventions to classification based physical therapy completed baseline questionnaires for pain catastrophizing (PCS), fear-avoidance beliefs (FABQ-PA, FABQ-W), and patient-specific fear (FDAQ). Clinical outcomes were pain intensity and disability measured at baseline, 4-weeks, and 6-months. A hierarchical agglomerative cluster analysis was used to create distinct cluster profiles among FAM measures and discriminant analysis was used to interpret clusters. Changes in clinical outcomes were investigated with repeated measures ANOVA and differences in results based on cluster membership were compared to FABQ-PA subgrouping used in the original trial. Results Three distinct FAM subgroups (Low Risk, High Specific Fear, and High Fear & Catastrophizing) emerged from cluster analysis. Subgroups differed on baseline pain and disability (p’s<.01) with the High Fear & Catastrophizing subgroup associated with greater pain than the Low Risk subgroup (p<.01) and the greatest disability (p’s<.05). Subgroup × time interactions were detected for both pain and disability (p’s<.05) with the High Fear & Catastrophizing subgroup reporting greater changes in pain and disability than other subgroups (p’s<.05). In contrast, FABQ-PA subgroups used in the original trial were not associated with interactions for clinical outcomes. Discussion These data suggest that subgrouping based on multiple FAM measures may provide additional information on clinical outcomes in comparison to determining subgroup status by FABQ-PA alone. Subgrouping methods for patients with LBP should include multiple psychological factors to further explore if patients can be matched with appropriate interventions. PMID:22510537

Neurobiological correlates of cognitions in fear and anxiety: a cognitive-neurobiological information-processing model.

PubMed

Hofmann, Stefan G; Ellard, Kristen K; Siegle, Greg J

2012-01-01

We review likely neurobiological substrates of cognitions related to fear and anxiety. Cognitive processes are linked to abnormal early activity reflecting hypervigilance in subcortical networks involving the amygdala, hippocampus, and insular cortex, and later recruitment of cortical regulatory resources, including activation of the anterior cingulate cortex and prefrontal cortex to implement avoidant response strategies. Based on this evidence, we present a cognitive-neurobiological information-processing model of fear and anxiety, linking distinct brain structures to specific stages of information processing of perceived threat.

Effects of vagus nerve stimulation on extinction of conditioned fear and post-traumatic stress disorder symptoms in rats.

PubMed

Noble, L J; Gonzalez, I J; Meruva, V B; Callahan, K A; Belfort, B D; Ramanathan, K R; Meyers, E; Kilgard, M P; Rennaker, R L; McIntyre, C K

2017-08-22

Exposure-based therapies help patients with post-traumatic stress disorder (PTSD) to extinguish conditioned fear of trauma reminders. However, controlled laboratory studies indicate that PTSD patients do not extinguish conditioned fear as well as healthy controls, and exposure therapy has high failure and dropout rates. The present study examined whether vagus nerve stimulation (VNS) augments extinction of conditioned fear and attenuates PTSD-like symptoms in an animal model of PTSD. To model PTSD, rats were subjected to a single prolonged stress (SPS) protocol, which consisted of restraint, forced swim, loss of consciousness, and 1 week of social isolation. Like PTSD patients, rats subjected to SPS show impaired extinction of conditioned fear. The SPS procedure was followed, 1 week later, by auditory fear conditioning (AFC) and extinction. VNS or sham stimulation was administered during half of the extinction days, and was paired with presentations of the conditioned stimulus. One week after completion of extinction training, rats were given a battery of behavioral tests to assess anxiety, arousal and avoidance. Results indicated that rats given SPS 1 week prior to AFC (PTSD model) failed to extinguish the freezing response after eleven consecutive days of extinction. Administration of VNS reversed the extinction impairment and attenuated reinstatement of the conditioned fear response. Delivery of VNS during extinction also eliminated the PTSD-like symptoms, such as anxiety, hyperarousal and social avoidance for more than 1 week after VNS treatment. These results provide evidence that extinction paired with VNS treatment can lead to remission of fear and improvements in PTSD-like symptoms. Taken together, these findings suggest that VNS may be an effective adjunct to exposure therapy for the treatment of PTSD.

Choosing to be afraid: preferences for fear as a function of goal pursuit.

PubMed

Tamir, Maya; Ford, Brett Q

2009-08-01

According to an instrumental approach to emotion regulation (M. Tamir, in press), people may not always prefer to feel pleasant emotions and avoid unpleasant ones. Instead, they may be motivated to experience even unpleasant emotions when they might be useful for goal attainment. Given that fear serves to promote successful avoidance, these studies tested this hypothesis by examining preferences for fear in preparation for avoidance goal pursuits. Consistent with the predictions of the instrumental approach, participants preferred to increase their level of fear as they prepared to pursue an avoidance goal. Such preferences were higher than preferences for either excitement or anger and were unique to avoidance (vs. approach or confrontational) goal pursuits. Given the aversive nature of fear, these findings clearly demonstrate that people may sometimes prefer to feel bad if doing so can lead to instrumental benefits. 2009 APA, all rights reserved.

Anxiety sensitivity moderates behavioral avoidance in anxious youth.

PubMed

Lebowitz, Eli R; Shic, Frederick; Campbell, Daniel; Basile, Krista; Silverman, Wendy K

2015-11-01

Individuals who are high in anxiety sensitivity (AS) are motivated to avoid sensations of anxiety. Consequently, AS is hypothesized to contribute to overall avoidance of any feared stimuli. No studies have yet examined whether fear of a stimulus is a stronger predictor of behavioral avoidance in individuals who are high in AS compared to individuals who are low in AS. We examined whether AS moderates the association between fear of spiders and behavioral avoidance of spider stimuli in 50 clinically anxious youth. Fear of spiders significantly predicted avoidance of spider stimuli in youth high in AS but not in youth low in AS. These results provide support for the role of AS in avoidant behavior and help to explain the link between AS and the anxiety disorders. The results have implications for exposure-based anxiety treatments and highlight the importance of increasing anxious patients' ability to tolerate sensations of anxiety. Copyright © 2015 Elsevier Ltd. All rights reserved.

Validation of the German fear of pain questionnaire in a sample of children with mixed chronic pain conditions.

PubMed

Flack, F; Gerlach, A L; Simons, L E; Zernikow, B; Hechler, T

2017-08-01

To date, no German instrument exists to measure pain-related fear in paediatric pain populations. The objective of the current study was to determine the construct validity of the translated German fear of pain questionnaire for children (GFOPQ-C) in a sample of children with mixed chronic pain disorders by testing the underlying factor structure, and its psychometric properties. N = 241 children with mixed chronic pain disorders (aged 8-19 years) presenting to a specialized pain clinic completed the GFOPQ-C and several other pain, fear and disability measures. The two-factor structure of the FOPQ-C (fear, avoidance) was replicated. Internal consistency for the shortened German version was good for both subscales (Fear subscale: α = 0.89; avoidance subscale: α = 0.76). As expected, the fear subscale correlated highly with anxiety sensitivity (r = 0.63), pain catastrophizing (r = 0.62) and general anxiety (r = 0.54), while the avoidance subscale was more closely related to disability (r = 0.24) and school functioning (r = 0.28). Pain-related fear differed in children with chronic pain depending on their pain location with higher fear ratings in children with abdominal pain and musculoskeletal pain. The GFOPQ-C is a valid instrument that assesses two distinct dimensions of pain-related fear in children: fear and avoidance. Future research is needed to evaluate the impact of increased pain-related fear on outcomes over time as well as to examine pain-related fear among healthy children. This will enhance our knowledge of who might be particularly vulnerable to potentially dysfunctional trajectories, such as ongoing pain or anxiety symptoms. The current study validates the first tool to assess pain-related fear in German-speaking children with chronic pain. Findings support two distinct domains: fear and activity avoidance. © 2017 European Pain Federation - EFIC®.

Assessing fear-avoidance beliefs in patients with cervical radiculopathy.

PubMed

Dedering, Asa; Börjesson, Tina

2013-12-01

The study sought to evaluate validity and reliability of the Fear Avoidance Beliefs Questionnaire and the Tampa Scale for Kinesiophobia in patients with cervical radiculopathy. A test-retest design was used to test stability over time in 46 patients with cervical radiculopathy. Differences between patients and healthy subjects were also evaluated comparing the patients with 41 physically active and healthy subjects. The patients answered the Fear Avoidance Beliefs Questionnaire and the Tampa Scale for Kinesiophobia twice. To test for differences between the patients and the healthy subjects, the latter answered the same questionnaires once. Questionnaires about activity, personal factors and health were also used. The test-retest reliability assessed with weighted kappa was 0.68 for the Fear Avoidance Beliefs Questionnaire and 0.45 for the Tampa Scale for Kinesiophobia. Only six of the 11 single items of the Fear Avoidance Beliefs Questionnaire and none of the single items of the Tampa Scale of Kinesiophobia showed kappa coefficients exceeding 0.60 (good reliability). Patients with cervical radiculopathy rated significantly worse on the Fear Avoidance Beliefs Questionnaire and the Tampa Scale for Kinesiophobia than the healthy subjects did. The Fear Avoidance Beliefs Questionnaire may be recommended for test-retest evaluations because 'good' reliability was found. The Tampa Scale for Kinesiophobia had only 'moderate' test-retest reliability, and this should be considered when using this scale in test-retest evaluations. Both questionnaires can discriminate between patients with cervical radiculopathy and healthy subjects. Copyright © 2012 John Wiley & Sons, Ltd.

Suffering in silence: Investigating the role of fear in the relationship between abusive supervision and defensive silence.

PubMed

Kiewitz, Christian; Restubog, Simon Lloyd D; Shoss, Mindy K; Garcia, Patrick Raymund James M; Tang, Robert L

2016-05-01

Drawing from an approach-avoidance perspective, we examine the relationships between subordinates' perceptions of abusive supervision, fear, defensive silence, and ultimately abusive supervision at a later time point. We also account for the effects of subordinates' assertiveness and individual perceptions of a climate of fear on these predicted mediated relationships. We test this moderated mediation model with data from three studies involving different sources collected across various measurement periods. Results corroborated our predictions by showing (a) a significant association between abusive supervision and subordinates' fear, (b) second-stage moderation effects of subordinates' assertiveness and their individual perceptions of a climate of fear in the abusive supervision-fear-defensive silence relationship (with lower assertiveness and higher levels of climate-of-fear perceptions exacerbating the detrimental effects of fear resulting from abusive supervision), and (c) first-stage moderation effects of subordinates' assertiveness and climate-of-fear perceptions in a model linking fear to defensive silence and abusive supervision at a later time. Theoretical and practical implications are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Avoidance learning: a review of theoretical models and recent developments

PubMed Central

Krypotos, Angelos-Miltiadis; Effting, Marieke; Kindt, Merel; Beckers, Tom

2015-01-01

Avoidance is a key characteristic of adaptive and maladaptive fear. Here, we review past and contemporary theories of avoidance learning. Based on the theories, experimental findings and clinical observations reviewed, we distill key principles of how adaptive and maladaptive avoidance behavior is acquired and maintained. We highlight clinical implications of avoidance learning theories and describe intervention strategies that could reduce maladaptive avoidance and prevent its return. We end with a brief overview of recent developments and avenues for further research. PMID:26257618

The paths leading from attachment to ageism: a structural equation model approach.

PubMed

Bodner, Ehud; Cohen-Fridel, Sara

2014-01-01

The study introduces a model in which attachment patterns serve as predictors, empathy and fear of death as mediators, and ageism as the predicted variable. Data were collected from young adults (N = 440). Anxious attachment was directly and positively correlated with ageism, and also indirectly and positively by the mediator "fear of death." Avoidant attachment was indirectly and negatively correlated with ageism by the mediator "empathy". It is suggested that interventions for reducing ageist attitudes among younger adults would focus on existential fears, as well as on empathic ability, according to the attachment tendencies of these individuals.

Synchrony-Desynchrony in the Tripartite Model of Fear: Predicting Treatment Outcome in Clinically Phobic Children

PubMed Central

Allen, Kristy Benoit; Allen, Ben; Austin, Kristin E.; Waldron, Jonathan C.; Ollendick, Thomas H.

2015-01-01

The tripartite model of fear posits that the fear response entails three loosely coupled components: subjective distress, behavioral avoidance, and physiological arousal. The concept of synchrony vs. desynchrony describes the degree to which changes in the activation of these components vary together (synchrony), independently, or inversely (both forms of desynchrony) over time. The present study assessed synchronony-desynchrony and its relationship to treatment outcome in a sample of 98 children with specific phobias both prior to and 1 week after receiving one-session treatment, a 3 hour cognitive-behavioral intervention. The results suggest an overall pattern of desynchronous change whereby youth improved on behavioral avoidance and subjective distress following treatment, but their level of cardiovascular reactivity remained stable. However, we found evidence that synchronous change on the behavioral avoidance and subjective distress components was related to better treatment outcome, whereas desynchronous change on these components was related to poorer treatment outcome. These findings suggest that a fuller understanding of the three response systems and their interrelations in phobic youth may assist us in the assessment and treatment of these disorders, potentially leading to a more person-centered approach and eventually to enhanced treatment outcomes. PMID:26073497

Harm avoidance and disability in old age.

PubMed

Wilson, Robert S; Buchman, Aron S; Arnold, Steven E; Shah, Raj C; Tang, Yuxiao; Bennett, David A

2006-01-01

The relation of personality to disability in old age is not well understood. The authors examined the relation of harm avoidance, a trait indicating a tendency to worry, fear uncertainty, be shy, and tire easily, to disability in a group of 474 older persons without dementia. Participants completed the 35-item Harm Avoidance scale. Disability was assessed with the Rosow-Breslau scale, a self-report measure of physical mobility. Performance-based tests of lower limb functions were also administered from which composite measures of gait, balance, and strength were derived. In a logistic regression model controlled for age, sex, education, and lower limb function, persons with high levels of harm avoidance were nearly three times as likely to report mobility limitations as persons with low levels, and these effects largely reflected fatigability and fear of uncertainty. The association of harm avoidance with disability was not explained or modified by frailty, physical activity, depressive symptoms, neuroticism, extraversion, or cognition. The results suggest that harm avoidance is associated with disability in old age.

Parental social anxiety disorder prospectively predicts toddlers' fear/avoidance in a social referencing paradigm.

PubMed

Aktar, Evin; Majdandžić, Mirjana; de Vente, Wieke; Bögels, Susan M

2014-01-01

Anxiety runs in families. Observational learning of anxious behavior from parents with anxiety disorders plays an important role in the intergenerational transmission of anxiety. We investigated the link between parental anxiety (parental lifetime anxiety disorders and expressed parental anxiety) and toddler fear/avoidance during social referencing (SR) situations. Toddlers (N = 117) participated with both parents (with lifetime social anxiety disorder, other nonsocial anxiety disorders, lifetime comorbid social and other anxiety disorders, or without anxiety disorders) in a longitudinal study. Behavioral inhibition (BI) was measured at 12 months via observational tasks. At 30 months, children were confronted with a stranger and a remote-control robot in SR situations, separately with each parent. Children's fear and avoidance, and parents' expressions of anxiety, encouragement, and overcontrol were observed. Toddlers of parents with lifetime social anxiety disorder (alone and comorbid with other anxiety disorders) showed more fear/avoidance in SR situations than toddlers of parents without anxiety disorders, while the effect of other anxiety disorders alone was not significant. Although expressed parental anxiety at 30 months in SR situations did not significantly predict toddlers' fear/avoidance, higher levels of expressed anxiety at 12 months in SR situations by parents with comorbid social and other anxiety disorders predicted higher levels of fear/avoidance. BI at 12 months predicted toddlers' fear/avoidance only with mothers, but not with fathers. Parental lifetime social anxiety disorders may be a stronger predictor of children's fear/avoidance than parents' expressions of anxiety in SR situations in toddlerhood. End of infancy may be a sensitive time for learning of anxiety from parents with comorbid lifetime social and nonsocial anxiety disorders in SR situations. Fathers are as important as mothers in the transmission of anxiety via SR. Furthermore, children may act relatively free of their early temperament in SR situations with fathers. © 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.

Memory suppression trades prolonged fear and sleep-dependent fear plasticity for the avoidance of current fear

NASA Astrophysics Data System (ADS)

Kuriyama, Kenichi; Honma, Motoyasu; Yoshiike, Takuya; Kim, Yoshiharu

2013-07-01

Sleep deprivation immediately following an aversive event reduces fear by preventing memory consolidation during homeostatic sleep. This suggests that acute insomnia might act prophylactically against the development of posttraumatic stress disorder (PTSD) even though it is also a possible risk factor for PTSD. We examined total sleep deprivation and memory suppression to evaluate the effects of these interventions on subsequent aversive memory formation and fear conditioning. Active suppression of aversive memory impaired retention of event memory. However, although the remembered fear was more reduced in sleep-deprived than sleep-control subjects, suppressed fear increased, and seemed to abandon the sleep-dependent plasticity of fear. Active memory suppression, which provides a psychological model for Freud's ego defense mechanism, enhances fear and casts doubt on the potential of acute insomnia as a prophylactic measure against PTSD. Our findings bring into question the role of sleep in aversive-memory consolidation in clinical PTSD pathophysiology.

Why do fearful facial expressions elicit behavioral approach? Evidence from a combined approach-avoidance implicit association test.

PubMed

Hammer, Jennifer L; Marsh, Abigail A

2015-04-01

Despite communicating a "negative" emotion, fearful facial expressions predominantly elicit behavioral approach from perceivers. It has been hypothesized that this seemingly paradoxical effect may occur due to fearful expressions' resemblance to vulnerable, infantile faces. However, this hypothesis has not yet been tested. We used a combined approach-avoidance/implicit association test (IAT) to test this hypothesis. Participants completed an approach-avoidance lever task during which they responded to fearful and angry facial expressions as well as neutral infant and adult faces presented in an IAT format. Results demonstrated an implicit association between fearful facial expressions and infant faces and showed that both fearful expressions and infant faces primarily elicit behavioral approach. The dominance of approach responses to both fearful expressions and infant faces decreased as a function of psychopathic personality traits. Results suggest that the prosocial responses to fearful expressions observed in most individuals may stem from their associations with infantile faces. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Models and mechanisms of anxiety: evidence from startle studies

PubMed Central

Grillon, Christian

2009-01-01

Rationale Preclinical data indicates that threat stimuli elicit two classes of defensive behaviors, those that are associated with imminent danger and are characterized by avoidance or fight (fear), and those that are associated with temporally uncertain danger and are characterized by sustained apprehension and hypervigilance (anxiety). Objective To 1) review evidence for a distinction between fear and anxiety in animal and human experimental models using the startle reflex as an operational measure of aversive states, 2) describe experimental models of anxiety, as opposed to fear, in humans, 3) examine the relevance of these models to clinical anxiety. Results The distinction between phasic fear to imminent threat and sustained anxiety to temporally uncertain danger is suggested by psychopharmacological and behavioral evidence from ethological studies and can be traced back to distinct neuroanatomical systems, the amygdala and the bed nucleus of the stria terminalis. Experimental models of anxiety, not fear, are relevant to non-phobic anxiety disorders. Conclusions Progress in our understanding of normal and abnormal anxiety is critically dependent on our ability to model sustained aversive states to temporally uncertain threat. PMID:18058089

The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review.

PubMed

Wertli, Maria M; Rasmussen-Barr, Eva; Weiser, Sherri; Bachmann, Lucas M; Brunner, Florian

2014-05-01

Psychological factors including fear avoidance beliefs are believed to influence the development of chronic low back pain (LBP). The purpose of this study was to determine the prognostic importance of fear avoidance beliefs as assessed by the Fear Avoidance Beliefs Questionnaire (FABQ) and the Tampa Scale of Kinesiophobia for clinically relevant outcomes in patients with nonspecific LBP. The design of this study was a systematic review. In October 2011, the following databases were searched: BIOSIS, CINAHL, Cochrane Library, Embase, OTSeeker, PeDRO, PsycInfo, PubMed/Medline, Scopus, and Web of Science. To ensure the completeness of the search, a hand search and a search of bibliographies was conducted and all relevant references included. A total of 2,031 references were retrieved, leaving 566 references after the removal of duplicates. For 53 references, the full-text was assessed and, finally, 21 studies were included in the analysis. The most convincing evidence was found supporting fear avoidance beliefs to be a prognostic factor for work-related outcomes in patients with subacute LBP (ie, 4 weeks-3 months of LBP). Four cohort studies, conducted by disability insurance companies in the United States, Canada, and Belgium, included 258 to 1,068 patients mostly with nonspecific LBP. These researchers found an increased risk for work-related outcomes (not returning to work, sick days) with elevated FABQ scores. The odds ratio (OR) ranged from 1.05 (95% confidence interval [CI] 1.02-1.09) to 4.64 (95% CI, 1.57-13.71). The highest OR was found when applying a high cutoff for FABQ Work subscale scores. This may indicate that the use of cutoff values increases the likelihood of positive findings. This issue requires further study. Fear avoidance beliefs in very acute LBP (<2 weeks) and chronic LBP (>3 months) was mostly not predictive. Evidence suggests that fear avoidance beliefs are prognostic for poor outcome in subacute LBP, and thus early treatment, including interventions to reduce fear avoidance beliefs, may avoid delayed recovery and chronicity. Copyright © 2014 Elsevier Inc. All rights reserved.

Component analysis and initial validity of the exercise fear avoidance scale.

PubMed

Wingo, Brooks C; Baskin, Monica; Ard, Jamy D; Evans, Retta; Roy, Jane; Vogtle, Laura; Grimley, Diane; Snyder, Scott

2013-01-01

To develop the Exercise Fear Avoidance Scale (EFAS) to measure fear of exercise-induced discomfort. We conducted principal component analysis to determine component structure and Cronbach's alpha to assess internal consistency of the EFAS. Relationships between EFAS scores, BMI, physical activity, and pain were analyzed using multivariate regression. The best fit was a 3-component structure: weight-specific fears, cardiorespiratory fears, and musculoskeletal fears. Cronbach's alpha for the EFAS was α=.86. EFAS scores significantly predicted BMI, physical activity, and PDI scores. Psychometric properties of this scale suggest it may be useful for tailoring exercise prescriptions to address fear of exercise-related discomfort.

Avoidance temperament and social-evaluative threat in college students' math performance: a mediation model of math and test anxiety.

PubMed

Liew, Jeffrey; Lench, Heather C; Kao, Grace; Yeh, Yu-Chen; Kwok, Oi-man

2014-01-01

Standardized testing has become a common form of student evaluation with high stakes, and limited research exists on understanding the roles of students' personality traits and social-evaluative threat on their academic performance. This study examined the roles of avoidance temperament (i.e., fear and behavioral inhibition) and evaluative threat (i.e., fear of failure and being viewed as unintelligent) in standardized math test and course grades in college students. Undergraduate students (N=184) from a large public university were assessed on temperamental fear and behavioral inhibition. They were then given 15 minutes to complete a standardized math test. After the test, students provided data on evaluative threat and their math performance (scores on standardized college entrance exam and average grades in college math courses). Results indicate that avoidance temperament was linked to social-evaluative threat and low standardized math test scores. Furthermore, evaluative threat mediated the influence of avoidance temperament on both types of math performance. Results have educational and clinical implications, particularly for students at risk for test anxiety and underperformance. Interventions targeting emotion regulation and stress management skills may help individuals reduce their math and test anxieties.

The Relation between the Fear-Avoidance Model and Constructs from the Social Cognitive Theory in Acute WAD.

PubMed

Sandborgh, Maria; Johansson, Ann-Christin; Söderlund, Anne

2016-01-01

In the fear-avoidance (FA) model social cognitive constructs could add to explaining the disabling process in whiplash associated disorder (WAD). The aim was to exemplify the possible input from Social Cognitive Theory on the FA model. Specifically the role of functional self-efficacy and perceived responses from a spouse/intimate partner was studied. A cross-sectional and correlational design was used. Data from 64 patients with acute WAD were used. Measures were pain intensity measured with a numerical rating scale, the Pain Disability Index, support, punishing responses, solicitous responses, and distracting responses subscales from the Multidimensional Pain Inventory, the Catastrophizing subscale from the Coping Strategies Questionnaire, the Tampa Scale of Kinesiophobia, and the Self-Efficacy Scale. Bivariate correlational, simple linear regression, and multiple regression analyses were used. In the statistical prediction models high pain intensity indicated high punishing responses, which indicated high catastrophizing. High catastrophizing indicated high fear of movement, which indicated low self-efficacy. Low self-efficacy indicated high disability, which indicated high pain intensity. All independent variables together explained 66.4% of the variance in pain disability, p < 0.001. Results suggest a possible link between one aspect of the social environment, perceived punishing responses from a spouse/intimate partner, pain intensity, and catastrophizing. Further, results support a mediating role of self-efficacy between fear of movement and disability in WAD.

Dental Fear and Avoidance in Treatment Seekers at a Large, Urban Dental Clinic.

PubMed

Heyman, Richard E; Slep, Amy M Smith; White-Ajmani, Mandi; Bulling, Lisanne; Zickgraf, Hana F; Franklin, Martin E; Wolff, Mark S

2016-01-01

The prevalence and correlates of dental fear have been studied in representative population studies, but not in patients presenting for dental treatment. We hypothesized that dental fear among patients presenting at a large, urban college of dentistry would be similar to that of the population (e.g. 11% high dental fear, 17% to 35% moderate or higher fear) and that fear would be associated with avoidance of routine dental care, increased use of urgent dental care and poor oral health. Participants were 1070 consecutive patients at a large, urban dental care center. All patients completed a clinical interview, including demographics, medical history, dental history and presenting concerns, and behavioral health history. Patients were also asked to rate their dental anxiety/fear on a 1 (none) to 10 (high) scale. Over 20% of patients reported elevated anxiety/fear, of which 12.30% reported moderate and 8.75% high fear. Severity of dental anxiety/fear was strongly related to the likelihood of avoiding dental services in the past and related to myriad presenting problems. As hypothesized, the prevalence of moderate or higher fear in dental patients was considerable and closely matched that found in general population surveys. Thus, the 'dental home' is an ideal location to treat clinically significant dental anxiety/fear.

The Development of a Technology-Based Hierarchy to Assess Chronic Low Back Pain and Pain-Related Anxiety From a Fear-Avoidance Model.

PubMed

Springer, Kristen S; George, Steven Z; Robinson, Michael E

2016-08-01

Previous studies have not examined the assessment of chronic low back pain (CLBP) and pain-related anxiety from a fear avoidance model through the use of motion-capture software and virtual human technologies. The aim of this study was to develop and assess the psychometric properties of an interactive, technologically based hierarchy that can be used to assess patients with pain and pain-related anxiety. We enrolled 30 licensed physical therapists and 30 participants with CLBP. Participants rated 21 video clips of a 3-D animated character (avatar) engaging in activities that are typically feared by patients with CLBP. The results of the study indicate that physical therapists found the virtual hierarchy clips acceptable and depicted realistic patient experiences. Most participants with CLBP reported at least 1 video clip as being sufficiently anxiety-provoking for use clinically. Therefore, this study suggests a hierarchy of fears can be created out of 21 virtual patient video clips paving the way for future clinical use in patients with CLBP. This report describes the development of a computer-based virtual patient system for the assessment of back pain-related fear and anxiety. Results show that people with back pain as well as physical therapists found the avatar to be realistic, and the depictions of behavior anxiety- and fear-provoking. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Response inhibition predicts painful task duration and performance in healthy individuals performing a cold pressor task in a motivational context.

PubMed

Karsdorp, P A; Geenen, R; Vlaeyen, J W S

2014-01-01

Long-term avoidance of painful activities has shown to be dysfunctional in chronic pain. Pain may elicit escape or avoidance responses automatically, particularly when pain-related fear is high. A conflict may arise between opposing short-term escape/avoidance goals to reduce pain and long-term approach goals to receive a reward. An inhibitory control system may resolve this conflict. It was hypothesized that reduced response inhibition would be associated with greater escape/avoidance during pain, particularly among subjects with higher pain-related fear. Response inhibition was measured with the stop-signal task, and pain-related fear with the Fear of Pain Questionnaire. Participants completed a tone-detection task (TDT) in which they could earn money while being exposed to cold pressor pain. Escape/avoidance was operationalized as the hand immersion time during a cold pressor task (CPT) and the performance on the TDT. Poorer response inhibition was associated with shorter CPT immersion duration and with worse TDT performance. Pain after the CPT was associated with pain-related fear, but not with response inhibition. No supportive evidence was found for the hypothesis that the relation between inhibition and escape/avoidance would be most pronounced for those with higher pain-related fear. In contrast, the relation between response inhibition and number of hits on the TDT was most pronounced for those with lower pain-related fear. The findings suggest that individuals with a stronger ability to inhibit responses in a stop-signal task are better able to inhibit escape/avoidance responses elicited by pain, in the service of a conflicting approach goal. © 2013 European Pain Federation - EFIC®

The link between negative emotions and eating disorder behaviour in patients with anorexia nervosa.

PubMed

Espeset, Ester M S; Gulliksen, Kjersti S; Nordbø, Ragnfrid H S; Skårderud, Finn; Holte, Arne

2012-11-01

Several theoretical models suggest that deficits in emotional regulation are central in the maintenance of anorexia nervosa (AN). Few studies have examined how patients view the relationship between negative affect and anorectic behaviour. We explored how patients with AN manage the aversive emotions sadness, anger, fear and disgust, and how they link these experiences to their eating disorder behaviours. Qualitative data were collected through semi-structured interviews with 14 women aged 19-39 years diagnosed with AN (DSM-IV). Interviews were analyzed using Grounded Theory methods. The participants tended to inhibit expression of sadness and anger in interpersonal situations and reported high levels of anger towards themselves, self-disgust and fear of becoming fat. Different emotions were managed by means of specific eating disorder behaviours. Sadness was particularly linked to body dissatisfaction and was managed through restrictive eating and purging. Anger was avoided by means of restrictive eating and purging and released through anorectic self-control, self-harm and exercising. Fear was linked to fear of fatness and was managed through restrictive eating, purging and body checking. Participants avoided the feeling of disgust by avoiding food and body focused situations. Treatment models of eating disorders highlight the significance of working with emotional acceptance and coping in this patient group. Knowledge about how patients understand the relationships between their negative emotions and their anorectic behaviour may be an important addition to treatment programmes for AN. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.

Learning and extinction of a passive avoidance response in mice with high levels of predisposition to catalepsy.

PubMed

Dubrovina, N I; Zinov'ev, D R; Zinov'eva, D V; Kulikov, A V

2009-06-01

This report presents results obtained from comparative analysis of learning and the dynamics of extinction of a conditioned passive avoidance response in ASC mice, which were bred for a high level of predisposition to catalepsy, and in CBA and AKR mice. The following findings were obtained: 1) impairments to the extinction of the memory of fear represent an important symptom of depression in ASC mice; 2) extinction is delayed in CBA mice; and 3) new inhibitory learning occurs quickly in AKR mice. Prolonged retention of the fear memory in ASC mice appears to be related to increased anxiety on prolonged testing without a punishment. The deficit of inhibition of the fear reaction in ASC mice allows this strain to be regarded as a genetic model of depression.

Joking about cancer as an avoidance strategy among US adults.

PubMed

Carcioppolo, Nick; John, Kevin K; Jensen, Jakob D; King, Andy J

2017-12-13

Findings from years of research on fear appeals suggest that individuals with low efficacy utilize avoidance strategies when they perceive a significant threat-a process called fear control. Some research suggests that joking could be an avoidance strategy. The current study identifies conditions in which people are more likely to joke about colorectal cancer and explores how this behavior may be associated with screening avoidance. Older adults (N = 209) recruited from eight different worksites completed a survey measuring fear appeal constructs and enactment of colorectal cancer-related joking. Results of a moderated mediation analysis suggest that men were more likely to joke about colorectal cancer than women, particularly if they perceived significant threat but had limited self-efficacy, signifying fear control. Results support prior fear appeal research, suggesting that an increase in joking behavior concerning colorectal cancer may be indicative of screening avoidance, and describe belief-based mechanisms that explain differences between biological sex and joking. Published by Oxford University Press 2017. This work is written by US Government employees and is in the public domain in the US.

Flexibility in the face of fear: Hippocampal-prefrontal regulation of fear and avoidance.

PubMed

Moscarello, Justin M; Maren, Stephen

2018-02-01

Generating appropriate defensive behaviors in the face of threat is essential to survival. Although many of these behaviors are 'hard-wired', they are also flexible. For example, Pavlovian fear conditioning generates learned defensive responses, such as conditioned freezing, that can be suppressed through extinction. The expression of extinguished responses is highly context-dependent, allowing animals to engage behavioral responses appropriate to the contexts in which threats are encountered. Likewise, animals and humans will avoid noxious outcomes if given the opportunity. In instrumental avoidance learning, for example, animals overcome conditioned defensive responses, including freezing, in order to actively avoid aversive stimuli. Recent work has greatly advanced understanding of the neural basis of these phenomena and has revealed common circuits involved in the regulation of fear. Specifically, the hippocampus and medial prefrontal cortex play pivotal roles in gating fear reactions and instrumental actions, mediated by the amygdala and nucleus accumbens, respectively. Because an inability to adaptively regulate fear and defensive behavior is a central component of many anxiety disorders, the brain circuits that promote flexible responses to threat are of great clinical significance.

Environmental transmission of generalized anxiety disorder from parents to children: worries, experiential avoidance, and intolerance of uncertainty

PubMed Central

Aktar, Evin; Nikolić, Milica; Bögels, Susan M.

2017-01-01

Generalized anxiety disorder (GAD) runs in families. Building on recent theoretical approaches, this review focuses on potential environmental pathways for parent-to-child transmission of GAD. First, we address child acquisition of a generalized pattern of fearful/anxious and avoidant responding to potential threat from parents via verbal information and via modeling. Next, we address how parenting behaviors may contribute to maintenance of fearful/anxious and avoidant reactions in children. Finally, we consider intergenerational transmission of worries as a way of coping with experiential avoidance of strong negative emotions and with intolerance of uncertainty. We conclude that parents with GAD may bias their children's processing of potential threats in the environment by conveying the message that the world is not safe, that uncertainty is intolerable, that strong emotions should be avoided, and that worry helps to cope with uncertainty, thereby transmitting cognitive styles that characterize GAD. Our review highlights the need for research on specific pathways for parent-to-child transmission of GAD. PMID:28867938

Environmental transmission of generalized anxiety disorder from parents to children: worries, experiential avoidance, and intolerance of uncertainty.

PubMed

Aktar, Evin; Nikolić, Milica; Bögels, Susan M

2017-06-01

Generalized anxiety disorder (GAD) runs in families. Building on recent theoretical approaches, this review focuses on potential environmental pathways for parent-to-child transmission of GAD. First, we address child acquisition of a generalized pattern of fearful/anxious and avoidant responding to potential threat from parents via verbal information and via modeling. Next, we address how parenting behaviors may contribute to maintenance of fearful/anxious and avoidant reactions in children. Finally, we consider intergenerational transmission of worries as a way of coping with experiential avoidance of strong negative emotions and with intolerance of uncertainty. We conclude that parents with GAD may bias their children's processing of potential threats in the environment by conveying the message that the world is not safe, that uncertainty is intolerable, that strong emotions should be avoided, and that worry helps to cope with uncertainty, thereby transmitting cognitive styles that characterize GAD. Our review highlights the need for research on specific pathways for parent-to-child transmission of GAD.

An evidence-based information booklet helps reduce fear-avoidance beliefs after first-time discectomy for disc prolapse.

PubMed

Claus, D; Coudeyre, E; Chazal, J; Irthum, B; Mulliez, A; Givron, P

2017-04-01

We aimed to assess the impact of a booklet integrating the biopsychosocial model of chronic pain management on reducing disability among patients undergoing lumbar discetomy. In a prospective, controlled, time-series study with an alternate-month design, we enrolled 129 patients from a tertiary care university hospital after they underwent uncomplicated lumbar discectomy for the first time. The intervention group received the biopsychosocial evidence-based booklet and the control group a biomedical-based booklet; the booklets differed only in information content. Patients were blinded to treatment group. The main outcome was disability at 2 months (measured by the Quebec back-pain disability scale [QBPDS]). Secondary outcomes were fear and avoidance beliefs measured by the Fear-Avoidance Beliefs Questionnaire (FABQ). All data were collected by self-reporting questionnaires. At 2 months, disability did not differ between the 2 groups (QBPDS score 32.4±22.8 vs 36.1±18.7, P=0.36). FABQ physical activity score was lower with the evidenced-based booklet as compared with controls (8.0±7.14 vs 11.2±6.3, P=0.008). Providing an evidence-based booklet had no effect at 2 months after surgery on disability but reduced fear-avoidance beliefs about physical activity. This booklet could be an effective tool for health care professionals in helping with patient education. CLINICALTRIALS. NCT00761111. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Synchrony-desynchrony in the tripartite model of fear: Predicting treatment outcome in clinically phobic children.

PubMed

Benoit Allen, Kristy; Allen, Ben; Austin, Kristin E; Waldron, Jonathan C; Ollendick, Thomas H

2015-08-01

The tripartite model of fear posits that the fear response entails three loosely coupled components: subjective distress, behavioral avoidance, and physiological arousal. The concept of synchrony vs. desynchrony describes the degree to which changes in the activation of these components vary together (synchrony), independently, or inversely (both forms of desynchrony) over time. The present study assessed synchrony-desynchrony and its relationship to treatment outcome in a sample of 98 children with specific phobias both prior to and 1 week after receiving one-session treatment, a 3 h cognitive-behavioral intervention. The results suggest an overall pattern of desynchronous change whereby youth improved on behavioral avoidance and subjective distress following treatment, but their level of cardiovascular reactivity remained stable. However, we found evidence that synchronous change on the behavioral avoidance and subjective distress components was related to better treatment outcome, whereas desynchronous change on these components was related to poorer treatment outcome. These findings suggest that a fuller understanding of the three response systems and their interrelations in phobic youth may assist us in the assessment and treatment of these disorders, potentially leading to a more person-centered approach and eventually to enhanced treatment outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Pain and fear avoidance partially mediate change in muscle strength during resistance exercise in women with fibromyalgia.

PubMed

Larsson, Anette; Palstam, Annie; Löfgren, Monika; Ernberg, Malin; Bjersing, Jan; Bileviciute-Ljungar, Indre; Gerdle, Björn; Kosek, Eva; Mannerkorpi, Kaisa

2017-11-21

Resistance exercise results in health benefits in fibromyalgia. The aim of this study was to determine the factors that mediate change in muscle strength in women with fibromyalgia as a result of resistance exercise. Sixty-seven women with fibromyalgia (age range 25-64 years) were included. Tests of muscle strength and questionnaires related to pain, fear avoidance and physical activity were carried out. Multivariable stepwise regression was used to analyse explanatory factors for change and predictors for final values of knee-extension force, elbow-flexion force and hand-grip force. Change in knee-extension force was explained by fear avoidance beliefs about physical activity at baseline, together with change in pain intensity, knee-extension force at baseline, age and body mass index (BMI) (R2=0.40, p = 0.013). Change in elbow-flexion force was explained by pain intensity at baseline, together with baseline fear avoidance beliefs about physical activity, BMI and elbow-flexion force at baseline (R2 = 0.32, p = 0.043). Change in hand-grip force was explained by hand-grip force at baseline, change in pain intensity and baseline fear avoidance (R2 = 0.37, p = 0.009). Final muscle strength was predicted by the same variables as change, except pain. Pain and fear avoidance are important factors to consider in rehabilitation using resistance exercise for women with fibromyalgia.

The Fear of Pain Questionnaire (FOPQ): assessment of pain-related fear among children and adolescents with chronic pain.

PubMed

Simons, Laura E; Sieberg, Christine B; Carpino, Elizabeth; Logan, Deirdre; Berde, Charles

2011-06-01

An important construct in understanding pain-related disability is pain-related fear. Heightened pain-related fear may result in behavioral avoidance leading to disuse, disability, and depression; whereas confrontation of avoided activities may result in a reduction of fear over time and reengagement with activities of daily living. Although there are several measures to assess pain-related fear among adults with chronic pain, none exist for children and adolescents. The aim of the current study was to develop a new tool to assess avoidance and fear of pain with pediatric chronic pain patients: the Fear of Pain Questionnaire, child report (FOPQ-C), and Fear of Pain Questionnaire, parent proxy report (FOPQ-P). After initial pilot testing, the FOPQ-C and FOPQ-P were administered to 299 youth with chronic pain and their parents at an initial multidisciplinary pain treatment evaluation. The FOPQ demonstrated very strong internal consistency of .92 for the child and parent versions. One-month stability estimates were acceptable and suggested responsivity to change. For construct validity, the FOPQ correlated with generalized anxiety, pain catastrophizing, and somatization. Evidence of criterion-related validity was found with significant associations for the FOPQ with pain, healthcare utilization, and functional disability. These results support the FOPQ as a psychometrically sound measure. Pain-related fear plays an important role in relation to emotional distress and pain-related disability among children and adolescents with chronic pain. Identification of patients with high levels of fear avoidance of pain with the FOPQ will inform how to proceed with psychological and physical therapy interventions for chronic pain. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

Self-Presentation Strategies, Fear of Success and Anticipation of Future Success among University and High School Students.

PubMed

Kosakowska-Berezecka, Natasza; Jurek, Paweł; Besta, Tomasz; Badowska, Sylwia

2017-01-01

The backlash avoidance model (BAM) suggests women insufficiently self-promote because they fear backlash for behavior which is incongruent with traditional gender roles. Avoiding self-promoting behavior is also potentially related to associating success with negative consequences. In two studies we tested whether self-promotion and fear of success will be predictors of lower salaries and anticipation of lower chances of success in an exam. In study 1, prior to the exam they were about to take, we asked 234 students about their predictions concerning exam results and their future earnings. They also filled scales measuring their associations with success (fear of success) and tendency for self-promotion. The tested model proved that in comparison to men, women expect lower salaries in the future, anticipate lower test performance and associate success with more negative consequences. Both tendency for self-promotion and fear of success are related to anticipation of success in test performance and expectations concerning future earnings. In study 2 we repeated the procedure on a sample of younger female and male high school pupils ( N = 100) to verify whether associating success with negative consequences and differences in self-promotion strategies are observable in a younger demographic. Our results show that girls and boys in high school do not differ with regard to fear of success, self-promotion or agency levels. Girls and boys anticipated to obtain similar results in math exam results, but girls expected to have higher results in language exams. Nevertheless, school pupils also differed regarding their future earnings but only in the short term. Fear of success and agency self-ratings were significant predictors of expectations concerning future earnings, but only among high school boys and with regard to earnings expected just after graduation.

Self-Presentation Strategies, Fear of Success and Anticipation of Future Success among University and High School Students

PubMed Central

Kosakowska-Berezecka, Natasza; Jurek, Paweł; Besta, Tomasz; Badowska, Sylwia

2017-01-01

The backlash avoidance model (BAM) suggests women insufficiently self-promote because they fear backlash for behavior which is incongruent with traditional gender roles. Avoiding self-promoting behavior is also potentially related to associating success with negative consequences. In two studies we tested whether self-promotion and fear of success will be predictors of lower salaries and anticipation of lower chances of success in an exam. In study 1, prior to the exam they were about to take, we asked 234 students about their predictions concerning exam results and their future earnings. They also filled scales measuring their associations with success (fear of success) and tendency for self-promotion. The tested model proved that in comparison to men, women expect lower salaries in the future, anticipate lower test performance and associate success with more negative consequences. Both tendency for self-promotion and fear of success are related to anticipation of success in test performance and expectations concerning future earnings. In study 2 we repeated the procedure on a sample of younger female and male high school pupils (N = 100) to verify whether associating success with negative consequences and differences in self-promotion strategies are observable in a younger demographic. Our results show that girls and boys in high school do not differ with regard to fear of success, self-promotion or agency levels. Girls and boys anticipated to obtain similar results in math exam results, but girls expected to have higher results in language exams. Nevertheless, school pupils also differed regarding their future earnings but only in the short term. Fear of success and agency self-ratings were significant predictors of expectations concerning future earnings, but only among high school boys and with regard to earnings expected just after graduation. PMID:29163271

Vigilance-avoidance and disengagement are differentially associated with fear and avoidant behaviors in social anxiety.

PubMed

Evans, Travis C; Walukevich, Katherine A; Britton, Jennifer C

2016-07-15

Individuals with Social Anxiety Disorder (SAD) often exhibit preferential attention for social threat, demonstrating abnormal orientation to threat (i.e., vigilance-avoidance) and/or difficulty disengaging from threat. However, no research has compared the relationship between attention indices (i.e., vigilance-avoidance, difficulty disengaging from threat) and characteristic features of the disorder such as fear during social situations (social fear) and avoidant behaviors (social avoidance). To address this issue, seventy adults (19.29±1.47 years, 33 females) were separated into low (n=37) or high (n=33) socially anxious groups using clinical cutoff scores on the Social Interaction Anxiety Scale (SIAS). Participants in both groups completed a dot-probe task with congruent, incongruent, and neutral trials to obtain measures of vigilance-avoidance and difficulty disengaging. Using linear regression, we examined the associations each attention index shared with self-reported social fear and social avoidance. Exclusively in the high anxious group, greater vigilance towards threat was associated with higher self-reported social fear, but not with social avoidance. However, difficulty disengaging was not associated with either social measure. In the low anxiety group, no relationships between attention indices and either social measure emerged. Future research with clinical samples is necessary to replicate and extend these findings. The small sample size studied may have limited our ability to detect other smaller effects. Indices of attention bias may contribute differently to the etiology and maintenance of SAD, which offers important implications for novel treatments that target attention. Copyright © 2016 Elsevier B.V. All rights reserved.

The differential relationship between mental contamination and the core dimensions of contact contamination fear.

PubMed

Melli, Gabriele; Bulli, Francesco; Carraresi, Claudia; Tarantino, Federica; Gelli, Simona; Poli, Andrea

2017-01-01

Two types of contamination fear are recognized: contact and mental contamination. Contact contamination appears to be motivated both by harm avoidance and disgust avoidance. This study aimed to examine the relationships between disgust propensity, mental contamination and contact contamination while differentiating between harm avoidance and disgust avoidance in contact contamination. 169 OCD patients completed a set of questionnaires assessing mental contamination, contact contamination, disgust propensity, OCD, anxiety and depression. 1) Contact contamination based on disgust avoidance was more strongly associated with mental contamination and disgust propensity than contact contamination based on harm avoidance; 2) mental contamination significantly predicted contact contamination based on disgust avoidance, while it did not predict contact contamination based on harm avoidance; 3) mental contamination had a significant mediational role in the relationship between disgust propensity and contact contamination motivated by disgust avoidance. Mental contamination plays a role in contact contamination fear when disgust is primarily experienced. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Interplay between Expressed Parental Anxiety and Infant Behavioural Inhibition Predicts Infant Avoidance in a Social Referencing Paradigm

ERIC Educational Resources Information Center

Aktar, Evin; Majdandzic, Mirjana; de Vente, Wieke; Bogels, Susan M.

2013-01-01

Background: Anxiety aggregates in families. Environmental factors, such as modelling of anxious behaviours, are assumed to play a causal role in the development of child anxiety. We investigated the predictive value of paternal and maternal anxiety (lifetime anxiety disorders and expressed parental anxiety) on infants' fear and avoidance during…

Maladaptive behavioral consequences of conditioned fear-generalization: a pronounced, yet sparsely studied, feature of anxiety pathology.

PubMed

van Meurs, Brian; Wiggert, Nicole; Wicker, Isaac; Lissek, Shmuel

2014-06-01

Fear-conditioning experiments in the anxiety disorders focus almost exclusively on passive-emotional, Pavlovian conditioning, rather than active-behavioral, instrumental conditioning. Paradigms eliciting both types of conditioning are needed to study maladaptive, instrumental behaviors resulting from Pavlovian abnormalities found in clinical anxiety. One such Pavlovian abnormality is generalization of fear from a conditioned danger-cue (CS+) to resembling stimuli. Though lab-based findings repeatedly link overgeneralized Pavlovian-fear to clinical anxiety, no study assesses the degree to which Pavlovian overgeneralization corresponds with maladaptive, overgeneralized instrumental-avoidance. The current effort fills this gap by validating a novel fear-potentiated startle paradigm including Pavlovian and instrumental components. The paradigm is embedded in a computer game during which shapes appear on the screen. One shape paired with electric-shock serves as CS+, and other resembling shapes, presented in the absence of shock, serve as generalization stimuli (GSs). During the game, participants choose whether to behaviorally avoid shock at the cost of poorer performance. Avoidance during CS+ is considered adaptive because shock is a real possibility. By contrast, avoidance during GSs is considered maladaptive because shock is not a realistic prospect and thus unnecessarily compromises performance. Results indicate significant Pavlovian-instrumental relations, with greater generalization of Pavlovian fear associated with overgeneralization of maladaptive instrumental-avoidance. Copyright © 2014 Elsevier Ltd. All rights reserved.

Immediate Extinction Attenuates Spontaneous Recovery and Reinstatement in a Passive Avoidance Paradigm.

PubMed

Briggs, James F; Fava, Devin A

2016-08-01

Recent research suggests that extinction occurring shortly after fear conditioning attenuates spontaneous recovery and reinstatement of fear. Two experiments investigated whether immediate extinction would prevent spontaneous recovery and reinstatement of fear using a passive avoidance paradigm. In Experiment 1, naive female adult rats (N = 40) received extinction training either immediately or 24 hours (delayed) after fear conditioning. Both extinction groups showed a significant reduction in fear at a 1-day test. At a 15-day test, spontaneous recovery was observed in the delayed extinction group while the immediate extinction group continued to show significant extinction. In Experiment 2, using a naive group of adult female rats (N = 16), the extinction result was replicated in both the immediate and delayed extinction groups at the 1-day interval. Reinstatement of fear, elicited by foot-shock in a neutral environment, was observed for the delayed group but not for the immediate group. By utilizing the passive-avoidance paradigm, these experiments replicate and extend previous findings that immediate extinction attenuates spontaneous recovery and reinstatement of fear. © The Author(s) 2016.

Systematic review of back schools, brief education, and fear-avoidance training for chronic low back pain.

PubMed

Brox, J I; Storheim, K; Grotle, M; Tveito, T H; Indahl, A; Eriksen, H R

2008-01-01

Seven previous systematic reviews (SRs) have evaluated back schools, and one has evaluated brief education, with the latest SR including studies until November 2004. The effectiveness of fear-avoidance training has not been assessed. To assess the effectiveness of back schools, brief education, and fear-avoidance training for chronic low back pain (CLBP). A SR. We searched the MEDLINE database of randomized controlled trials (RCT) until August 2006 for relevant trials reported in English. Assessment of effectiveness was based on pain, disability, and sick leave. RCTs that reported back schools, or brief education as the main intervention, were included. For fear-avoidance training, evaluation of domain-specific outcome was required. Two reviewers independently reviewed the studies. Eight RCTs including 1,002 patients evaluated back schools, three studies were of high quality. We found conflicting evidence for back schools compared with waiting list, placebo, usual care, and exercises, and a cognitive behavioral back school. Twelve trials including 3,583 patients evaluated brief education. Seven trials, six of high quality, evaluated brief education in the clinical setting. We found strong evidence of effectiveness on sick leave and short-term disability compared with usual care. We found conflicting or limited evidence for back book or Internet discussion (five trials, two of high quality) compared with waiting list, no intervention, massage, yoga, or exercises. Three RCTs of high quality, including 364 patients, evaluated fear-avoidance training. We found moderate evidence that there is no difference between rehabilitation including fear-avoidance training and spinal fusion. Consistent recommendations are given for brief education in the clinical setting, and fear-avoidance training should be considered as an alternative to spinal fusion, and back schools may be considered in the occupational setting. The discordance between reviews can be attributed differences in inclusion criteria and application of evidence rules.

Social Fear Learning: from Animal Models to Human Function.

PubMed

Debiec, Jacek; Olsson, Andreas

2017-07-01

Learning about potential threats is critical for survival. Learned fear responses are acquired either through direct experiences or indirectly through social transmission. Social fear learning (SFL), also known as vicarious fear learning, is a paradigm successfully used for studying the transmission of threat information between individuals. Animal and human studies have begun to elucidate the behavioral, neural and molecular mechanisms of SFL. Recent research suggests that social learning mechanisms underlie a wide range of adaptive and maladaptive phenomena, from supporting flexible avoidance in dynamic environments to intergenerational transmission of trauma and anxiety disorders. This review discusses recent advances in SFL studies and their implications for basic, social and clinical sciences. Copyright © 2017 Elsevier Ltd. All rights reserved.

Learning to avoid spiders: fear predicts performance, not competence.

PubMed

Luo, Xijia; Becker, Eni S; Rinck, Mike

2018-01-05

We used an immersive virtual environment to examine avoidance learning in spider-fearful participants. In 3 experiments, participants were asked to repeatedly lift one of 3 virtual boxes, under which either a toy car or a spider appeared and then approached the participant. Participants were not told that the probability of encountering a spider differed across boxes. When the difference was large (Exps. 1 and 2), spider-fearfuls learned to avoid spiders by lifting the few-spiders-box more often and the many-spiders-box less often than non-fearful controls did. However, they hardly managed to do so when the probability differences were small (Exp. 3), and they did not escape from threat more quickly (Exp. 2). In contrast to the observed performance differences, spider-fearfuls and non-fearfuls showed equal competence, that is comparable post-experimental knowledge about the probability to encounter spiders under the 3 boxes. The limitations and implications of the present study are discussed.

Fear of feces? Trade-offs between disease risk and foraging drive animal activity around raccoon latrines

USGS Publications Warehouse

Weinstein, Sara B.; Moura, Chad W.; Mendez, Jon Francis; Lafferty, Kevin D.

2017-01-01

Fear of predation alters prey behavior, which can indirectly alter entire landscapes. A parasite-induced ecology of fear might also exist if animals avoid parasite-contaminated resources when infection costs outweigh foraging benefits. To investigate whether animals avoid parasite contaminated sites, and if such avoidance balances disease costs and foraging gains, we monitored animal behavior at raccoon latrines – sites that concentrate both seeds and pathogenic parasite eggs. Using wildlife cameras, we documented over 40 potentially susceptible vertebrate species in latrines and adjacent habitat. Latrine contact rates reflected background activity, diet preferences and disease risk. Disease-tolerant raccoons and rats displayed significant site attraction, while susceptible birds and small mammals avoided these high-risk sites. This suggests that parasites, like predators, might create a landscape of fear for vulnerable hosts. Such non-consumptive parasite effects could alter disease transmission, population dynamics, and even ecosystem structure.

The impact of illness-related shame on psychological health and social relationships: Testing a mediational model in students with chronic illness.

PubMed

Trindade, Inês A; Duarte, Joana; Ferreira, Cláudia; Coutinho, Mariana; Pinto-Gouveia, José

2018-05-01

This study explores the impact of illness-related shame on the quality of social relationships and psychological health in chronic patients. We aimed to examine the roles of fear of receiving compassion from others and experiential avoidance as potential mediators of this relationship. Although some studies have demonstrated the negative impact of chronic illness-related shame on psychological functioning, the mechanisms that may underlie this link remain understudied. The sample was comprised by 115 college students, which had been diagnosed with at least 1 chronic illness. Participants completed self-report measures on an online platform. This study's design was cross-sectional. A path analysis was conducted using structural equation modelling. Results showed that the impact of illness-related shame on both psychological health (R 2  = .45) and the quality of social relationships (R 2  = .33) was fully accounted by fear of compassion from others and experiential avoidance. This model revealed an excellent fit. Fear of receiving compassion from others was the main mediator of the illness-related shame link with the quality of social relationships (β = -.22). The main mediator of the association between shame-related chronic illness and psychological health was experiential avoidance (β = -.21).This study shed light on possible psychological mechanisms linking feelings of shame associated with having a chronic condition and impaired social relationships and mental health. On one hand, resisting feelings of compassion and care from others and, on the other hand, avoiding difficult internal experiences and situations that might trigger them seem to underlie the impact of shame on psychological and social functioning in chronic patients. Copyright © 2018 John Wiley & Sons, Ltd.

The time course of location-avoidance learning in fear of spiders.

PubMed

Rinck, Mike; Koene, Marieke; Telli, Sibel; Moerman-van den Brink, Wiltine; Verhoeven, Barbara; Becker, Eni S

2016-01-01

Two experiments were designed to study the time course of avoidance learning in spider fearfuls (SFs) under controlled experimental conditions. To achieve this, we employed an immersive virtual environment (IVE): While walking freely through a virtual art museum to search for specific paintings, the participants were exposed to virtual spiders. Unbeknown to the participants, only two of four museum rooms contained spiders, allowing for avoidance learning. Indeed, the more SF the participants were, the faster they learned to avoid the rooms that contained spiders (Experiment. 1), and within the first six trials, high fearfuls already developed a preference for starting their search task in rooms without spiders (Experiment 2). These results illustrate the time course of avoidance learning in SFs, and they speak to the usefulness of IVEs in fundamental anxiety research.

Fear of hypoglycaemia in parents of young children with type 1 diabetes: a systematic review.

PubMed

Barnard, Katharine; Thomas, Sian; Royle, Pamela; Noyes, Kathryn; Waugh, Norman

2010-07-15

Many children with type 1 diabetes have poor glycaemic control. Since the Diabetes Control and Complications Trial (DCCT) showed that tighter control reduces complication rates, there has been more emphasis on intensified insulin therapy. We know that patients and families are afraid of hypoglycaemia. We hypothesised that fear of hypoglycaemia might take precedence over concern about long-term complications, and that behaviour to avoid hypoglycaemia might be at the cost of poorer control, and aimed to evaluate the effectiveness of any interventions designed to prevent that. The objective of this review was to systematically review studies concerning the extent and consequences of fear of hypoglycaemia in parents of children under 12 years of age with type 1 diabetes, and interventions to reduce it. MEDLINE, EMBASE, PsycINFO, The Cochrane Library, Web of Science, meeting abstracts of EASD, ADA and Diabetes UK, Current Controlled Trials, ClinicalTrials.gov, UK CRN, scrutiny of bibliographies of retrieved papers and contact with experts in the field.Inclusions: Relevant studies of any design of parents of children under 12 years of age with Type 1 diabetes were included. The key outcomes were the extent and impact of fear, hypoglycaemia avoidance behaviour in parents due to parental fear of hypoglycaemia in their children, the effect on diabetes control, and the impact of interventions to reduce this fear and hypoglycaemia avoidance behaviour. Eight articles from six studies met the inclusion criteria. All were cross sectional studies and most were of good quality. Parental fear of hypoglycaemia, anxiety and depression were reported to be common. There was a paucity of evidence on behaviour to avoid hypoglycaemia, but there were some suggestions that higher than desirable blood glucose levels might be permitted in order to avoid hypoglycaemia. No studies reporting interventions to reduce parental fear of hypoglycaemia were found. The evidence base was limited. Parents of children with Type 1 diabetes reported considerable parental fear of hypoglycaemia, affecting both parental health and quality of life. There is some suggestion that hypoglycaemia avoidance behaviours by parents might adversely affect glycaemic control. Trials of interventions to reduce parental anxiety and hypoglycaemia avoidance behaviour are needed. We suggest that there should be a trial of structured education for parents of young children with Type 1 diabetes.

Impaired extinction of fear and maintained amygdala-hippocampal theta synchrony in a mouse model of temporal lobe epilepsy.

PubMed

Lesting, Jörg; Geiger, Matthias; Narayanan, Rajeevan T; Pape, Hans-Christian; Seidenbecher, Thomas

2011-02-01

The relationship between epilepsy and fear has received much attention. However, seizure-modulated fear and physiologic or structural correlates have not been examined systematically, and the underlying basics of network levels remain unclear to date. Therefore, this project was set up to characterize the neurophysiologic basis of seizure-related fear and the contribution of the amygdala-hippocampus system. The experimental strategy was composed of the following steps: (1) use of the mouse pilocarpine model of temporal lobe epilepsy (TLE); (2) behavioral analyses of anxiety states in the elevated plus maze test, light-dark avoidance test, and Pavlovian fear conditioning; and (3) probing neurophysiologic activity patterns in amygdala-hippocampal circuits in freely behaving mice. Our results displayed no significant differences in basic anxiety levels comparing mice that developed spontaneous recurrent seizures (SRS) and controls. Furthermore, conditioned fear memory retrieval was not influenced in SRS mice. However, during fear memory extinction, SRS mice showed an extended freezing behavior and a maintained amygdala-hippocampal theta frequency synchronization compared to controls. These results indicate specific alterations in conditioned fear behavior and related neurophysiologic activities in the amygdala-hippocampal network contributing to impaired fear memory extinction in mice with TLE. Clinically, the nonextinguished fear memories may well contribute to the experience of fear in patients with TLE. Wiley Periodicals, Inc. © 2010 International League Against Epilepsy.

Mechanisms of change underlying the efficacy of cognitive behaviour therapy for chronic fatigue syndrome in a specialist clinic: a mediation analysis.

PubMed

Stahl, D; Rimes, K A; Chalder, T

2014-04-01

Several randomized controlled trials (RCTs) have shown that cognitive behavioural psychotherapy (CBT) is an efficacious treatment for chronic fatigue syndrome (CFS). However, little is known about the mechanisms by which the treatment has its effect. The aim of this study was to investigate potential mechanisms of change underlying the efficacy of CBT for CFS. We applied path analysis and introduce novel model comparison approaches to assess a theoretical CBT model that suggests that fearful cognitions will mediate the relationship between avoidance behaviour and illness outcomes (fatigue and social adjustment). Data from 389 patients with CFS who received CBT in a specialist service in the UK were collected at baseline, at discharge from treatment, and at 3-, 6- and 12-month follow-ups. Path analyses were used to assess possible mediating effects. Model selection using information criteria was used to compare support for competing mediational models. Path analyses were consistent with the hypothesized model in which fear avoidance beliefs at the 3-month follow-up partially mediate the relationship between avoidance behaviour at discharge and fatigue and social adjustment respectively at 6 months. The results strengthen the validity of a theoretical model of CBT by confirming the role of cognitive and behavioural factors in CFS.

Clozapine and Olanzapine Exhibit an Intrinsic Anxiolytic Property in Two Conditioned Fear Paradigms: Contrast with Haloperidol and Chlordiazepoxide

PubMed Central

Mead, Alexa; Li, Ming; Kapur, Shitij

2008-01-01

Psychotic fear and anxiety disturbances are seen at a relatively high frequency in patients with schizophrenia. Atypical antipsychotics are believed to show superior efficacy in reducing these symptoms. However, clinical and preclinical evidence regarding their anxiolytic efficacy has been mixed. In this study, we evaluated the possible anxiolytic property of two atypicals clozapine and olanzapine and compared them with typical haloperidol and chlordiazepoxide (a prototype of sedative-anxiolytic drug) in two preclinical models of fear. In Experiment 1, we used a fear-induced passive avoidance and conditioned place aversion paradigm and examined the effects of clozapine (20 mg/kg, sc), haloperidol (0.05 mg/kg, sc) and chlordiazepoxide (10 mg/kg, ip). In Experiments 2 and 3, we used a two-way active avoidance conditioning paradigm and further compared the effects of clozapine (20 mg/kg, sc), haloperidol (0.05 mg/kg, sc), chlordiazepoxide (10 mg/kg, ip) and three doses of olanzapine (0.5, 1.0, and 2.0 mg/kg, sc). Results show that clozapine and chlordiazepoxide, but not haloperidol, significantly attenuated the shock conditioning-induced place aversion, decreased the amount of defecations and the number of the 22 kHz vocalizations. Clozapine also reduced the shock conditioning-induced hyperthermia. Similar to clozapine, olanzapine also significantly decreased the amount of defecations and reduced the shock conditioning-induced hyperthermia, but it did not inhibit the 22 kHz vocalizations. This study demonstrates that clozapine and olanzapine possess an intrinsic anxiolytic property, which is not attributable to its superior anti-“psychotic” effect or its favorable effects on motor functions or learning and memory processes. These findings also suggest that the combined use of passive avoidance and active avoidance conditioning models can be useful in better differentiating typical and atypical antipsychotics as well as anxiolytics. PMID:18547622

Pain-related avoidance versus endurance in primary care patients with subacute back pain: psychological characteristics and outcome at a 6-month follow-up.

PubMed

Hasenbring, Monika I; Hallner, Dirk; Klasen, Bernhard; Streitlein-Böhme, Irmgard; Willburger, Roland; Rusche, Herbert

2012-01-01

Recent research has found individual differences in back pain patients due to behavioral avoidance vs persistence. However, there is a lack of prospective studies of nonspecific low back pain patients. The avoidance-endurance model (AEM) suggests at least 3 pathways leading to chronic pain: fear-avoidance response, distress-endurance response, and eustress-endurance response. We sought to compare these 3 maladaptive subgroups with an adaptive group using a classification tool that included the following scales: the thought suppression and behavioral endurance subscale of the Avoidance-Endurance Questionnaire and the Beck Depression Inventory. The psychological characteristics, and pain and disability of the AEM subgroups were investigated. We report results from 177 patients with subacute nonspecific low back pain at the start of outpatient treatment and at follow-up after 6 months. At baseline, a multivariate analysis of variance found that the fear-avoidance patients scored higher in pain catastrophizing than the other groups. The distress-endurance patients displayed elevated anxiety/depression and helplessness/hopelessness accompanied with the highest scores in the classification variables thought suppression and persistence behavior. The eustress-endurance patients had the highest humor/distraction scores, pain persistence, and positive mood despite pain. All 3 maladaptive groups revealed a higher pain intensity than the adaptive patients at follow-up after 6 months; however, disability at follow-up was elevated only in the fear-avoidance and distress-endurance patients. The study provides preliminary evidence for the construct and prospective validity of AEM-based subgroups of subacute, nonspecific back pain patients. The results suggest the need for individually targeted cognitive behavioral treatments in the maladaptive groups. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Fear Avoidance and Clinical Outcomes from Mild Traumatic Brain Injury.

PubMed

Silverberg, Noah D; Panenka, William; Iverson, Grant L

2018-04-18

Characterizing psychological factors that contribute to persistent symptoms after mild traumatic brain injury (MTBI) can inform early intervention. To determine whether fear avoidance, a known risk factor for chronic disability after musculoskeletal injury, is associated with worse clinical outcomes from MTBI, adults were recruited from four outpatient MTBI clinics and assessed at their first clinic visit (M=2.7, SD=1.5 weeks post-injury) and again 4-5 months later. Of 273 patients screened, 102 completed the initial assessment and 87 returned for the outcome assessment. The initial assessment included a battery of questionnaires that measure activity avoidance and associated fears. Endurance, an opposite behavior pattern, was measured with the Behavioral Response to Illness Questionnaire. The multidimensional outcome assessment included measures of post-concussion symptoms (British Columbia Postconcussion Symptom Inventory), functional disability (World Health Organization Disability Assessment Schedule-12 2.0), return to work status, and psychiatric complications (MINI Neuropsychiatric Interview). A single component was retained from principal components analysis of the six avoidance subscales. In generalized linear modeling, the avoidance composite score predicted symptom severity (95% confidence interval [CI] for B= 1.22-6.33) and disability (95% CI for B=2.16-5.48), but not return to work (95% CI for B=-0.68-0.24). The avoidance composite was also associated with an increased risk for depression (OR=1.76, 95% CI=1.02-3.02) and anxiety disorders (OR=1.89, 95% CI=1.16-3.19). Endurance behavior predicted the same outcomes, except for depression. In summary, avoidance and endurance behavior were associated with a range of adverse clinical outcomes from MTBI. These may represent early intervention targets.

Neuroendocrine models of social anxiety disorder

PubMed Central

van Honk, Jack; Bos, Peter A.; Terburg, David; Heany, Sarah; Stein, Dan J.

2015-01-01

Social anxiety disorder (SAD) is a highly prevalent and disabling disorder with key behavioral traits of social fearfulness, social avoidance, and submissiveness. Here we argue that hormonal systems play a key role in mediating social anxiety, and so may be important in SAD. Hormonal alterations, often established early in development through the interaction between biological and psychological factors (eg, genetic predisposition x early trauma), predispose to socially fearful, avoidant, and submissive behavior. However, whereas gene variants and histories of trauma persist, hormonal systems can be remodeled over the course of life. Hormones play a key role during the periods of all sensitive developmental windows (ie, prenatal, neonatal, puberty, aging), and are capable of opening up new developmental windows in adulthood. Indeed, the developmental plasticity of our social brain, and thus of social behavior in adulthood, critically depends on steroid hormones such as testosterone and peptide hormones such as oxytocin. These steroid and peptide hormones in interaction with social experiences may have potential for reprogramming the socially anxious brain. Certainly, single administrations of oxytocin and testosterone in humans reduce socially fearful, avoidant, and submissive behavior. Such work may ultimately lead to new approaches to the treatment of SAD. PMID:26487809

Does heightened fear of crime lead to poorer mental health in new suburbs, or vice versa?

PubMed

Foster, Sarah; Hooper, Paula; Knuiman, Matthew; Giles-Corti, Billie

2016-11-01

Fear of crime is implicated as a risk factor for poorer mental health, yet few studies have explored whether there is a causal relationship between fear of crime and health, or tested the direction of the relationship. Does, for example, heightened fear of crime lead to poorer mental health, or could poorer mental health exacerbate fear of crime? RESIDE participants in Perth, Australia, completed a questionnaire three years after moving to their neighbourhood (2007-2008, n = 1230), and again four years later (2011-2012, n = 531). The impact of fear of crime on psychological distress (Kessler-6) was examined in SAS using the Proc Mixed procedure (marginal repeated measures model with unrestricted variance pattern). Models controlled for demographics and time, and progressively adjusted for avoidance behaviours (i.e., walking, community participation, social cohesion). This approach was repeated with psychological distress as the independent variable and fear of crime as the outcome. For each increase in one standard deviation (SD) in fear of crime, psychological distress increased by 0.680 (p = 0.0001), however in the reversed models, for each one SD increase in psychological distress, fear of crime increased by 0.152 (p = 0.0001). To help explain these results, temporal order models examined whether baseline values predicted follow-up values. There was a significant association between psychological distress (at baseline) and fear of crime (at follow-up), but no association between fear of crime (at baseline) and psychological distress (at follow-up). The findings suggest a bi-directional relationship exists between fear of crime and mental health, however it appears that higher psychological distress over time leads to higher fear of crime, rather than the reverse. Furthermore, the pathway connecting fear of crime and mental health appears to be direct, rather than via constrained social and physical activities. Copyright © 2016 Elsevier Ltd. All rights reserved.

A clinician guide to patients afraid of dental injections and numbness.

PubMed

Armfield, Jason M; Milgrom, Peter

2011-01-01

Fears of dental injections remain a clinical problem often requiring cognitive behavioural psychology counselling and sedation in order to carry out needed dental treatment. This study, based on a national survey in Australia, compared patient concerns about numbness caused by local anaesthesia and fears of the injection itself. It also examined associations between dental fearfulness and avoidance associated with patient self-reported negative experiences and treatment need. Clinical advice on how to approach such patients is offered. Relatively high levels of dental anxiety and fear have been reported in several industrialised Western societies (McGrath & Bedi, 2004; Armfield, Spencer & Stewart, 2006; Lahti et al., 2007; Enkling, Marwinski Jöhren, 2006). In the U.K., almost one in three adults consider themselves to always be anxious about going to the dentist (Nuttall et al., 2001). Of concern is that this dental fear may be passed on to the children of anxious adults (Nuttall, Gilbert & Morris, 2008), leading to an inter-generational perpetuation of the problem. There is considerable evidence that dental fear is related to poorer oral health, reduced dental attendance and increased treatment stress for the attending dentist. There are many aspects of going to a dentist that might elicit feelings of apprehension, concern or anxiety in prospective patients (Liddell & Gosse, 1998; Oosterink, de Jongh & Aartman, 2008). One of the most commonly reported concerns relates to receiving injections. Indeed, fear of needles and the treatment of injection fear has been an important focus of a research in the U.K. (Boyle, Newton & Milgrom, 2010). Needle fear, in particular, is a major issue given that the delivery of local anaesthesia via injection is the central plank of pain relief techniques in dentistry (Malamed, 2009) and dentists as well as patients often avoid difficult injections as a consequence, resulting in poor pain control. A less well described anxiety of receiving dental treatment is fear of numbness associated with the dental injection (Morse & Cohen, 1983). Certainly, many dentists believe that their patients avoid local anaesthesia because of a wish to avoid the disturbing effects of numbness (Moore et al., 1998). Milgrom et al. (1997) found that fears about the numbness associated with receiving local anaesthesia significantly differentiated avoiders and non-avoiders of dental treatment. However, these concerns appeared to be much less common than those concerning the perceived pain of injections and fear of bodily injury resulting from the injection (Milgrom et al., 1997; Kaako et al., 1998). Consistent with these findings, whereas 43% of English patients asked to imagine undergoing future third molar surgery expressed concerns primarily about pain, only 6% of patients indicated concern about numbness as their worst fear (Earl, 1994). More recently, a study of Dutch people found that the feeling of numbness from the anaesthesia was rated as the 41st most feared dental stimulus out of a list of 67 possible stimuli, and that only 1.5% of the general population regarded numbness as extremely anxiety provoking (Oosterink, de Jongh & Aartman, 2008). However, it is important for a clinician to differentiate between those who dislike the sensation of temporary numbness versus those who may worry that it may never wear off. Such problem thinking can be an issue irrespective of whether a patient overcomes the fear of needles with sedation or not. A large number of patients dislike the sensation of numbness enough for manufacturers to respond with a partial antidote in alpha adrenergic receptor antagonist phentolamine mesylate (OraVerse Sanofi-Aventis, Hersh & Lindemeyer, 2010). Approval of this agent, which shortens the length of soft tissue anaesthesia after inferior alveolar block, is pending in the UK and other European countries. In other cases, dentists resort to using local anaesthetics without vasoconstrictors to shorten the period of anaesthesia (Fiset, Getz, Milgrom & Weinstein, 1989). While the association between dental fear and fear of injections has received considerable attention, the relationship between dental fear and numbness has received less attention. In particular, the nature of the associations between dental fear and avoidance and anxiety over numbness has not been studied. There has also been no research into whether or not concerns over numbness are independent of injection concerns. Finally, the association between fear of numbness and injections and dental avoidance and treatment needs has not been investigated. This study, based on survey work in Australia, aimed to compare patient concerns about numbness caused by receiving anaesthesia to that of anxiety over the receipt of needles and injections. Associations with dental fear and avoidance as well as negative experiences and treatment needs were also explored.

Fear of movement, passive coping, manual handling, and severe or radiating pain increase the likelihood of sick leave due to low back pain.

PubMed

Dawson, Anna P; Schluter, Philip J; Hodges, Paul W; Stewart, Simon; Turner, Catherine

2011-07-01

Sick leave due to low back pain (LBP-SL) is costly and compromises workforce productivity. The fear-avoidance model asserts that maladaptive pain-related cognitions lead to avoidance and disuse, which can perpetuate ongoing pain. Staying home from work is an avoidant behavior, and hence pain-related psychological features may help explain LBP-SL. We examined the relative contribution of pain catastrophizing, fear of movement, and pain coping (active and passive) in LBP-SL in addition to pain characteristics and other psychosocial, occupational, general health, and demographic factors. Two-way interactions between age and gender and candidate exposures were also considered. Our sample comprised 2164 working nurses and midwives with low back pain in the preceding year. Binary logistic regression was performed on cross-sectional data by manual backward stepwise elimination of nonsignificant terms to generate a parsimonious multivariable model. From an extensive array of exposures assessed, fear of movement (women, odds ratio [OR]=1.05, 95% confidence interval [CI] 1.02-1.08; men, OR=1.17, 95% CI 1.05-1.29), passive coping (OR=1.07, 95% CI 1.04-1.11), pain severity (OR=1.61, 95% CI 1.50-1.72), pain radiation (women, OR=1.45, 95% CI 1.10-1.92; men, OR=4.13, 95% CI 2.15-7.95), and manual handling frequency (OR=1.03, 95% CI 1.01-1.05) increased the likelihood of LBP-SL in the preceding 12 months. Administrators and managers were less likely to report LBP-SL (OR=0.44, 95% CI 0.27-0.71), and age had a protective effect in individuals in a married or de facto relationship (OR=0.97, 95% CI 0.95-0.98). In summary, fear of movement, passive coping, frequent manual handling, and severe or radiating pain increase the likelihood of LBP-SL. Gender-specific responses to pain radiation and fear of movement are evident. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

The German Version of the Gaze Anxiety Rating Scale (GARS): Reliability and Validity

PubMed Central

Domes, Gregor; Marx, Lisa; Spenthof, Ines; Heinrichs, Markus

2016-01-01

Objective Fear of eye gaze and avoidance of eye contact are core features of social anxiety disorders (SAD). To measure self-reported fear and avoidance of eye gaze, the Gaze Anxiety Rating Scale (GARS) has been developed and validated in recent years in its English version. The main objectives of the present study were to psychometrically evaluate the German translation of the GARS concerning its reliability, factorial structure, and validity. Methods Three samples of participants were enrolled in the study. (1) A non-patient sample (n = 353) completed the GARS and a set of trait questionnaires to assess internal consistency, test-retest reliability, factorial structure, and concurrent and divergent validity. (2) A sample of patients with SAD (n = 33) was compared to a healthy control group (n = 30) regarding their scores on the GARS and the trait measures. Results The German GARS fear and avoidance scales exhibited excellent internal consistency and high stability over 2 and 4 months, as did the original version. The English version’s factorial structure was replicated, yielding two categories of situations: (1) everyday situations and (2) situations involving high evaluative threat. GARS fear and avoidance displayed convergent validity with trait measures of social anxiety and were markedly higher in patients with GSAD than in healthy controls. Fear and avoidance of eye contact in situations involving high levels of evaluative threat related more closely to social anxiety than to gaze anxiety in everyday situations. Conclusions The German version of the GARS has demonstrated reliability and validity similar to the original version, and is thus well suited to capture fear and avoidance of eye contact in different social situations as a valid self-report measure of social anxiety and related disorders in the social domain for use in both clinical practice and research. PMID:26937638

The German Version of the Gaze Anxiety Rating Scale (GARS): Reliability and Validity.

PubMed

Domes, Gregor; Marx, Lisa; Spenthof, Ines; Heinrichs, Markus

2016-01-01

Fear of eye gaze and avoidance of eye contact are core features of social anxiety disorders (SAD). To measure self-reported fear and avoidance of eye gaze, the Gaze Anxiety Rating Scale (GARS) has been developed and validated in recent years in its English version. The main objectives of the present study were to psychometrically evaluate the German translation of the GARS concerning its reliability, factorial structure, and validity. Three samples of participants were enrolled in the study. (1) A non-patient sample (n = 353) completed the GARS and a set of trait questionnaires to assess internal consistency, test-retest reliability, factorial structure, and concurrent and divergent validity. (2) A sample of patients with SAD (n = 33) was compared to a healthy control group (n = 30) regarding their scores on the GARS and the trait measures. The German GARS fear and avoidance scales exhibited excellent internal consistency and high stability over 2 and 4 months, as did the original version. The English version's factorial structure was replicated, yielding two categories of situations: (1) everyday situations and (2) situations involving high evaluative threat. GARS fear and avoidance displayed convergent validity with trait measures of social anxiety and were markedly higher in patients with GSAD than in healthy controls. Fear and avoidance of eye contact in situations involving high levels of evaluative threat related more closely to social anxiety than to gaze anxiety in everyday situations. The German version of the GARS has demonstrated reliability and validity similar to the original version, and is thus well suited to capture fear and avoidance of eye contact in different social situations as a valid self-report measure of social anxiety and related disorders in the social domain for use in both clinical practice and research.

Psychological Factors in Chronic Pelvic Pain in Women: Relevance and Application of the Fear-Avoidance Model of Pain

PubMed Central

Bishop, Mark D.

2011-01-01

Chronic pelvic pain in women is a debilitating, costly condition often treated by physical therapists. The etiology of this condition is multifactorial and poorly understood, given the complex interplay of muscles, bones, and soft tissue that comprise the pelvis. There are few guidelines directing treatment interventions for this condition. In the last decade, several investigators have highlighted the role of psychological variables in conditions such as vulvodynia and painful bladder syndrome. Pain-related fear is the focus of the fear-avoidance model (FAM) of pain, which theorizes that some people are more likely to develop and maintain pain after an injury because of their emotional and behavioral responses to pain. The FAM groups people into 2 classes on the basis of how they respond to pain: people who have low fear, confront pain, and recover from injury and people who catastrophize pain—a response that leads to avoidance/escape behaviors, disuse, and disability. Given the presence of pain-related cognitions in women with chronic pelvic pain, including hypervigilance, catastrophizing, and anxiety, research directed toward the application of the FAM to guide therapeutic interventions is warranted. Isolated segments of the FAM have been studied to theorize why traditional approaches (ie, medications and surgery) may not lead to successful outcomes. However, the explicit application of the FAM to guide physical therapy interventions for women with chronic pelvic pain is not routine. Integrating the FAM might direct physical therapists' clinical decision making on the basis of the pain-related cognitions and behaviors of patients. The aims of this article are to provide information about the FAM of musculoskeletal pain and to provide evidence for the relevance of the FAM to chronic pelvic pain in women. PMID:21835893

Amygdaloid and non-amygdaloid fear both influence avoidance of risky foraging in hungry rats

PubMed Central

Kim, Earnest; Kim, Eun Joo; Yeh, Regina; Shin, Minkyung; Bobman, Jake; Krasne, Franklin B.; Kim, Jeansok J.

2014-01-01

Considerable evidence seems to show that emotional and reflex reactions to feared situations are mediated by the amygdala. It might therefore seem plausible to expect that amygdala-coded fear should also influence decisions when animals make choices about instrumental actions. However, there is not good evidence of this. In particular, it appears, though the literature is conflicted, that once learning is complete, the amygdala may often not be involved in instrumental avoidance behaviours. It is therefore of interest that we have found in rats living for extended periods in a semi-naturalistic ‘closed economy’, where they were given random shocks in regions that had to be entered to obtain food, choices about feeding behaviour were in fact influenced by amygdala-coded fear, in spite of the null effect of amygdalar lesions on fear of dangerous location per se. We suggest that avoidance of highly motivated voluntary behaviour does depend in part on fear signals originating in the amygdala. Such signalling may be one role of well-known projections from amygdala to cortico-striate circuitry. PMID:25056616

Subjective anxiety and behavioral avoidance: Gender, gender role, and perceived confirmability of self-report.

PubMed

McLean, Carmen P; Hope, Debra A

2010-06-01

Commonly reported gender effects for differential vulnerability for anxiety may relate to gender socialization processes. The present study examined the relationship between gender role and fear under experimental conditions designed to elicit accurate fear reporting. Undergraduate students (N=119) completed several self-report measures and a behavioral avoidance task (BAT) with a tarantula while wearing a heart rate monitor. Gender roles were operationalized as instrumentality and expressiveness, as measured by the Personal Attributes Questionnaire (Spence, Helmreich, & Stapp, 1975). As expected, women reported greater subjective anxiety and were more avoidant of the tarantula than men. Regardless of gender, low levels of instrumentality were associated with greater avoidance of the tarantula. The hypothesis that men underreport fear compared to women and that gender role differences underlie this reporting bias was not supported. In spite of a ceiling effect on the BAT, results of this study confirm the relevance of gender role in understanding gender effects in fear and anxiety. Copyright 2010 Elsevier Ltd. All rights reserved.

Direction of attention bias to threat relates to differences in fear acquisition and extinction in anxious children.

PubMed

Waters, Allison M; Kershaw, Rachel

2015-01-01

Anxious children show attention biases towards and away from threat stimuli. Moreover, threat avoidance compared to vigilance predicts a poorer outcome from exposure-based treatments, such as cognitive-behavioural therapy (CBT), yet the mechanisms underlying this differential response are unclear. Pavlovian fear conditioning is a widely accepted theory to explain the acquisition and extinction of fear, including exposure-based treatments, such as CBT. In typical fear conditioning experiments, anxious children have shown larger physiological responses to an aversive unconditional stimulus (i.e., US on CS+ trials) and to non-reinforced stimuli (CS-) during fear acquisition and to both CSs during fear extinction compared to non-anxious peers. This study examined whether threat avoidance compared to threat vigilance was related to differences in fear acquisition and extinction in anxious children. Thirty-four clinically-anxious children completed a visual probe task including angry-neutral face pairs to determine the direction of threat attention bias as well as a discriminant conditioning and extinction task in which a geometric shape CS+ was paired with an aversive tone US, while the CS- geometric shape was always presented alone during acquisition trials. Both CSs were presented alone during extinction trials. Fear acquisition and extinction were indexed by skin conductance responses (SCR) and subjective measures. Children were classified as threat vigilant (N = 18) and threat avoidant (n = 16) based on the direction of threat attention bias on the visual probe task. During acquisition, threat avoidant relative to threat vigilant anxious children displayed larger orienting SCRs to both CSs during the first block of trials and larger third interval SCRs to the US on CS+ trials as well as on CS- trials. During extinction, threat avoidant anxious children showed delayed extinction of SCRs to both the CS+ and CS- and reported higher subjective anxiety ratings after extinction compared to threat vigilant anxious children. Threat avoidant anxious children may be more reactive physiologically to novel cues and to stimuli that become associated with threat and this may interfere with extinction learning. These findings could help explain previous evidence that threat avoidant anxious children do not respond as well as threat vigilant anxious children to exposure-based CBT. Copyright © 2014 Elsevier Ltd. All rights reserved.

Sources, responses and moderators of childbirth fear in Australian women: a qualitative investigation.

PubMed

Fenwick, J; Toohill, J; Creedy, D K; Smith, J; Gamble, J

2015-01-01

around 20% of women suffer childbirth fear causing them significant distress and often leading to requests for caesarean section. In Sweden, fearful pregnant women are offered counselling; however, in Australia, no dedicated service caters for the specific needs of these women. Indeed scant research has been conducted in Australia and little is known about women's concerns and if these align to those reported in the international literature. to describe the sources, responses and moderators of childbirth fear in a group of pregnant women assessed as having high levels of childbirth fear. comparative analysis was used to identify common concepts and generate themes that represented women's perspectives of childbirth fear. Data consisted of 43 tape recorded telephone conversations with highly fearful pregnant women who were participating in a large randomised controlled trial known as BELIEF (Birth Emotions, Looking to Improve Expectant Fear). women's fears were conceptualised into three themes: fear stimuli; fear responses; and fear moderators. Lack of confidence to birth, fear of the unknown, internalising other women's negative stories, perineal tearing and labour pain were common concerns for first time mothers. For multiparous women, not having had personal feelings resolved following their previous birth and negative experiences of last birth influenced current expectations for their upcoming birth. Themes common to both groups were: unmet information and support needs, feelings of loss of control and lack of input in to decision-making. Some women however, chose to avoid birth planning in order to cope during pregnancy. Australian women had similar childbirth concerns to those reported in the international literature. However unique to this study was finding two opposing discourses; one of preoccupation with negative events and the other; avoidance of planning for labour and birth. Provision of woman centred maternity models that minimise obstetric intervention, offer personalised conversations following birth, and are sensitive to identifying; listening and assisting women to modify their fears in early pregnancy are required to promote positive anticipation and preparation for birth. Copyright © 2014 Elsevier Ltd. All rights reserved.

Emotional neglect in childhood shapes social dysfunctioning in adults by influencing the oxytocin and the attachment system: Results from a population-based study.

PubMed

Müller, Laura E; Bertsch, Katja; Bülau, Konstatin; Herpertz, Sabine C; Buchheim, Anna

2018-06-01

Early life maltreatment (ELM) is the major single risk factor for impairments in social functioning and mental health in adulthood. One of the most prevalent and most rapidly increasing forms of ELM is emotional neglect. According to bio-behavioral synchrony assumptions, the oxytocin and attachment systems play an important mediating role in the interplay between emotional neglect and social dysfunctioning. Therefore, the aim of the present study was to investigate whether fear and avoidance of social functioning, two important and highly prevalent facets of social dysfunctioning in adulthood, are shaped by emotional neglect, plasma oxytocin levels and attachment representations. We assessed emotional neglect as well as other forms of ELM with the Childhood Trauma Questionnaire, current attachment representations with the Adult Attachment Projective Picture System, and fear and avoidance of social situations with the Liebowitz Social Anxiety Scale in a population-based sample of N = 121 men and women. Furthermore, 4.9 ml blood samples were drawn from each participant to assess peripheral plasma oxytocin levels. Applying a sequential mediation model, results revealed that emotional neglect was associated with lower plasma oxytocin levels which in turn were associated with insecure attachment representations which were related to elevated fear and avoidance of social situations (a 1 d 21 b 2 : F 3,117  = 20.84, P < .001). Plasma oxytocin and current attachment representations hence fully and sequentially mediate the effects of emotional neglect on social fear and avoidance, two important facets of adult social dysfunctioning, confirming bio-behavioral synchrony assumptions. Copyright © 2018. Published by Elsevier B.V.

Perceptual and conceptual similarities facilitate the generalization of instructed fear.

PubMed

Bennett, Marc; Vervoort, Ellen; Boddez, Yannick; Hermans, Dirk; Baeyens, Frank

2015-09-01

Learned fear can generalize to neutral events due their perceptual and conceptual similarity with threat relevant stimuli. This study simultaneously examined these forms of generalization to model the expansion of fear in anxiety disorders. First, artificial categories involving sounds, nonsense words and animal-like objects were established. Next, the words from one category were paired with threatening information while the words from the other category were paired with safety information. Lastly, we examined if fear generalized to (i) the conceptually related animal-like objects and (ii) other animal like-objects that were perceptually similar. This was measured using behavioral avoidance, US expectancy ratings and self-reported stimulus valence. Animal-like objects conceptually connected to the aversive words evoked heightened fear. Perceptual variants of these animal-like objects also elicit fear. Future research would benefit from the use of online-US expectancy ratings and physiological measures of fear. Investigating the role of both perceptual and conceptual fear generalization is important to better understand the etiology of anxiety disorders symptoms. Copyright © 2015 Elsevier Ltd. All rights reserved.

Anorexia nervosa as a motivated behavior: Relevance of anxiety, stress, fear and learning.

PubMed

Guarda, Angela S; Schreyer, Colleen C; Boersma, Gretha J; Tamashiro, Kellie L; Moran, Timothy H

2015-12-01

The high comorbidity between anorexia nervosa (AN) and anxiety disorders is well recognized. AN is a motivated behavioral disorder in which habit formation is likely to contribute to the persistence of abnormal eating and exercise behaviors. Secondary alterations in brain circuitry underlying the reward value of food and exercise, along with disturbances in neuroendocrine hunger and satiety signaling arising from starvation and excessive exercise, are likely contributors to the maintenance of anorectic behaviors in genetically vulnerable individuals. The potential role of fear conditioning in facilitating onset of AN, or of impaired fear extinction in contributing to the high relapse rates observed following weight restoration, is of interest. Evidence from animal models of anxiety and human laboratory studies indicate that low estrogen impairs fear extinction. Low estradiol levels in AN may therefore play a role in perpetuating fear of food and fat in recently weight restored patients. Translational models including the activity based anorexia (ABA) rodent model of AN, and neuroimaging studies of fear extinction and conditioning, could help clarify the underlying molecular mechanisms and neurocircuitry involved in food avoidance behaviors in AN. Moreover, the adaptation of novel treatment interventions with efficacy in anxiety disorders may contribute to the development of new treatments for this impairing disorder. Copyright © 2015. Published by Elsevier Inc.

Emotional predictors of bowel screening: the avoidance-promoting role of fear, embarrassment, and disgust.

PubMed

Reynolds, Lisa M; Bissett, Ian P; Consedine, Nathan S

2018-05-03

Despite considerable efforts to address practical barriers, colorectal cancer screening numbers are often low. People do not always act rationally, and investigating emotions may offer insight into the avoidance of screening. The current work assessed whether fear, embarrassment, and disgust predicted colorectal cancer screening avoidance. A community sample (N = 306) aged 45+ completed a questionnaire assessing colorectal cancer screening history and the extent that perceptions of cancer risk, colorectal cancer knowledge, doctor discussions, and a specifically developed scale, the Emotional Barriers to Bowel Screening (EBBS), were associated with previous screening behaviours and anticipated bowel health decision-making. Step-wise logistic regression models revealed that a decision to delay seeking healthcare in the hypothetical presence of bowel symptoms was less likely in people who had discussed risk with their doctor, whereas greater colorectal cancer knowledge and greater fear of a negative outcome predicted greater likelihood of delay. Having previously provided a faecal sample was predicted by discussions about risk with a doctor, older age, and greater embarrassment, whereas perceptions of lower risk predicted a lower likelihood. Likewise, greater insertion disgust predicted a lower likelihood of having had an invasive bowel screening test in the previous 5 years. Alongside medical and demographic factors, fear, embarrassment and disgust are worthy of consideration in colorectal cancer screening. Understanding how specific emotions impact screening decisions and behaviour is an important direction for future work and has potential to inform screening development and communications in bowel health.

The association between estradiol levels, hormonal contraceptive use, and responsiveness to one-session-treatment for spider phobia in women.

PubMed

Graham, Bronwyn M; Li, Sophie H; Black, Melissa J; Öst, Lars-Göran

2018-04-01

Preclinical studies have demonstrated that conditioned fear extinction is impaired in females with low endogenous levels of the sex hormone estradiol, due to menstrual fluctuations or hormonal contraceptive use. As fear extinction is a laboratory model of exposure therapy for anxiety and trauma disorders, here we assessed the hypothesis that treatment outcomes may be diminished when exposure therapy occurs during periods of low estradiol. 90 women with spider phobia (60 cycling and 30 using hormonal contraceptives) underwent a one-session exposure treatment for spider phobia, following which, serum estradiol levels were assessed. A median split in estradiol level was used to divide cycling participants into two groups; lower and higher estradiol. Behavioral avoidance and self-reported fear of spiders were measured pre-treatment, post-treatment, and at a 12 week follow-up assessment. Women using hormonal contraceptives exhibited a significantly slower rate of improvement across treatment, greater behavioral avoidance at post-treatment and follow-up, and fewer self-initiated post-treatment exposure tasks, relative to both groups of cycling women, who did not differ. No group differences in self-reported fear were evident. Correlational analyses revealed that across the whole sample, lower estradiol levels were associated with slower rates of improvement across treatment, and greater self-reported fear and behavioral avoidance at post-treatment, but not follow-up. These results provide the first evidence of an association between endogenous estradiol, hormonal contraceptive use, and exposure therapy outcomes in spider phobic women. Hormonal profile may partly account for variability in responsiveness to psychological treatments for anxiety and trauma disorders in women. Copyright © 2018 Elsevier Ltd. All rights reserved.

Increased anxiety but normal fear and safety learning in orexin-deficient mice.

PubMed

Khalil, Radwa; Fendt, Markus

2017-03-01

The loss of orexin neurons in humans leads to the disease narcolepsy, characterized by daytime sleepiness and cataplexy. Recent data suggest that orexin is also involved in emotional processing. The goal of the present study was to evaluate fear and safety learning as well as unconditioned fear (anxiety) in orexin-deficient animals. Orexin-deficient mice are an established animal model used to investigate the neuropathology and potential treatments for narcolepsy. Here, we present novel data showing that orexin-deficient mice express increased anxiety in the open field, light-dark box test and carnivore odor-induced avoidance, but are normal in fear and safety learning. These findings suggest an important role of orexin in brain areas involved in anxiety. Copyright © 2016 Elsevier B.V. All rights reserved.

Phobias and Preparedness - Republished Article.

PubMed

Seligman, Martin E P

2016-09-01

Some inadequacies of the classical conditioning analysis of phobias are discussed: phobias are highly resistant to extinction, whereas laboratory fear conditioning, unlike avoidance conditioning, extinguishes rapidly; phobias comprise a nonarbitrary and limited set of objects, whereas fear conditioning is thought to occur to an unlimited range of conditioned stimuli. Furthermore, phobias, unlike laboratory fear conditioning, are often acquired in one trial and seem quite resistant to change by "cognitive" means. An analysis of phobias using a more contemporary model of fear conditioning is proposed. In this view, phobias are seen as instances of highly "prepared" learning (Seligman, 1970). Such prepared learning is selective, highly resistant to extinction, probably noncognitive and can be acquired in one trial. A reconstruction of the notion of symbolism is suggested. Copyright © 2016 Elsevier Ltd. All rights reserved.

Fear of Failure, 2x2 Achievement Goal and Self-Handicapping: An Examination of the Hierarchical Model of Achievement Motivation in Physical Education

ERIC Educational Resources Information Center

Chen, Lung Hung; Wu, Chia-Huei; Kee, Ying Hwa; Lin, Meng-Shyan; Shui, Shang-Hsueh

2009-01-01

In this study, the hierarchical model of achievement motivation [Elliot, A. J. (1997). Integrating the "classic" and "contemporary" approaches to achievement motivation: A hierarchical model of approach and avoidance achievement motivation. In P. Pintrich & M. Maehr (Eds.), "Advances in motivation and achievement"…

Amygdaloid and non-amygdaloid fear both influence avoidance of risky foraging in hungry rats.

PubMed

Kim, Earnest; Kim, Eun Joo; Yeh, Regina; Shin, Minkyung; Bobman, Jake; Krasne, Franklin B; Kim, Jeansok J

2014-09-07

Considerable evidence seems to show that emotional and reflex reactions to feared situations are mediated by the amygdala. It might therefore seem plausible to expect that amygdala-coded fear should also influence decisions when animals make choices about instrumental actions. However, there is not good evidence of this. In particular, it appears, though the literature is conflicted, that once learning is complete, the amygdala may often not be involved in instrumental avoidance behaviours. It is therefore of interest that we have found in rats living for extended periods in a semi-naturalistic 'closed economy', where they were given random shocks in regions that had to be entered to obtain food, choices about feeding behaviour were in fact influenced by amygdala-coded fear, in spite of the null effect of amygdalar lesions on fear of dangerous location per se. We suggest that avoidance of highly motivated voluntary behaviour does depend in part on fear signals originating in the amygdala. Such signalling may be one role of well-known projections from amygdala to cortico-striate circuitry. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Fear of pain in children and adolescents with neuropathic pain and CRPS

PubMed Central

Simons, Laura E.

2015-01-01

A significant proportion of children and adolescents with chronic pain endorse elevated pain-related fear. Pain-related fear is associated with high levels of disability, depressive symptoms, and school impairment. Due to faulty nerve signaling, individuals with neuropathic pain and CRPS may be more prone to develop pain-related fear as they avoid use of and neglect the affected body area(s), resulting in exacerbated symptoms, muscle atrophy, maintenance of pain signaling, and ongoing pain-related disability. Not surprisingly, effective treatments for elevated pain-related fears involve exposure to previously avoided activities to down-regulate incorrect pain signaling. In the context of intensive interdisciplinary pain treatment of youth with neuropathic pain, decreasing pain-related fear is associated with improved physical and psychological functioning, while high initial pain-related fear is a risk factor for less treatment responsiveness. An innovative approach to targeting pain-related fear as well as evidence of a neural response to treatment involving decoupling of the amygdala with key fear circuits in youth with CRPS suggest breakthroughs in our ability to ameliorate these issues. PMID:26785161

Fear of pain in children and adolescents with neuropathic pain and complex regional pain syndrome.

PubMed

Simons, Laura E

2016-02-01

A significant proportion of children and adolescents with chronic pain endorse elevated pain-related fear. Pain-related fear is associated with high levels of disability, depressive symptoms, and school impairment. Because of faulty nerve signaling, individuals with neuropathic pain and complex regional pain syndrome may be more prone to develop pain-related fear as they avoid use of and neglect the affected body area(s), resulting in exacerbated symptoms, muscle atrophy, maintenance of pain signaling, and ongoing pain-related disability. Not surprisingly, effective treatments for elevated pain-related fears involve exposure to previously avoided activities to downregulate incorrect pain signaling. In the context of intensive interdisciplinary pain treatment of youth with neuropathic pain, decreasing pain-related fear is associated with improved physical and psychological functioning, whereas high initial pain-related fear is a risk factor for less treatment responsiveness. An innovative approach to targeting pain-related fear and evidence of a neural response to treatment involving decoupling of the amygdala with key fear circuits in youth with complex regional pain syndrome suggest breakthroughs in our ability to ameliorate these issues.

School Discipline: Better to Be Loved or Feared?

ERIC Educational Resources Information Center

Carey, Michael R.

1986-01-01

Asks whether Machiavelli or St. Benedict of Nursia provides the better model for school administration and student discipline. Finds Benedict's teachings, which stress love, prudence, and the avoidance of extremes, better suited to the traditions and spirituality of Catholic education. (DMM)

Dimensions Underlying Measures of Disability, Personal Factors, and Health Status in Cervical Radiculopathy

PubMed Central

Halvorsen, Marie; Kierkegaard, Marie; Harms-Ringdahl, Karin; Peolsson, Anneli; Dedering, Åsa

2015-01-01

Abstract This cross-sectional study sought to identify dimensions underlying measures of impairment, disability, personal factors, and health status in patients with cervical radiculopathy. One hundred twenty-four patients with magnetic resonance imaging-verified cervical radiculopathy, attending a neurosurgery clinic in Sweden, participated. Data from clinical tests and questionnaires on disability, personal factors, and health status were used in a principal-component analysis (PCA) with oblique rotation. The PCA supported a 3-component model including 14 variables from clinical tests and questionnaires, accounting for 73% of the cumulative percentage. The first component, pain and disability, explained 56%. The second component, health, fear-avoidance beliefs, kinesiophobia, and self-efficacy, explained 9.2%. The third component including anxiety, depression, and catastrophizing explained 7.6%. The strongest-loading variables of each dimension were “present neck pain intensity,” “fear avoidance,” and “anxiety.” The three underlying dimensions identified and labeled Pain and functioning, Health, beliefs, and kinesiophobia, and Mood state and catastrophizing captured aspects of importance for cervical radiculopathy. Since the variables “present neck pain intensity,” “fear avoidance,” and “anxiety” had the strongest loading in each of the three dimensions; it may be important to include them in a reduced multidimensional measurement set in cervical radiculopathy. PMID:26091482

Dimensions Underlying Measures of Disability, Personal Factors, and Health Status in Cervical Radiculopathy: A Cross-Sectional Study.

PubMed

Halvorsen, Marie; Kierkegaard, Marie; Harms-Ringdahl, Karin; Peolsson, Anneli; Dedering, Åsa

2015-06-01

This cross-sectional study sought to identify dimensions underlying measures of impairment, disability, personal factors, and health status in patients with cervical radiculopathy. One hundred twenty-four patients with magnetic resonance imaging-verified cervical radiculopathy, attending a neurosurgery clinic in Sweden, participated. Data from clinical tests and questionnaires on disability, personal factors, and health status were used in a principal-component analysis (PCA) with oblique rotation. The PCA supported a 3-component model including 14 variables from clinical tests and questionnaires, accounting for 73% of the cumulative percentage. The first component, pain and disability, explained 56%. The second component, health, fear-avoidance beliefs, kinesiophobia, and self-efficacy, explained 9.2%. The third component including anxiety, depression, and catastrophizing explained 7.6%. The strongest-loading variables of each dimension were "present neck pain intensity," "fear avoidance," and "anxiety." The three underlying dimensions identified and labeled Pain and functioning, Health, beliefs, and kinesiophobia, and Mood state and catastrophizing captured aspects of importance for cervical radiculopathy. Since the variables "present neck pain intensity," "fear avoidance," and "anxiety" had the strongest loading in each of the three dimensions; it may be important to include them in a reduced multidimensional measurement set in cervical radiculopathy.

Measuring Evaluation Fears in Adolescence: Psychometric Validation of the Portuguese Versions of the Fear of Positive Evaluation Scale and the Specific Fear of Negative Evaluation Scale

ERIC Educational Resources Information Center

Vagos, Paula; Salvador, Maria do Céu; Rijo, Daniel; Santos, Isabel M.; Weeks, Justin W.; Heimberg, Richard G.

2016-01-01

Modified measures of Fear of Negative Evaluation and Fear of Positive Evaluation were examined among Portuguese adolescents. These measures demonstrated replicable factor structure, internal consistency, and positive relationships with social anxiety and avoidance. Gender differences were found. Implications for evaluation and intervention are…

Fearing shades of grey: individual differences in fear responding towards generalisation stimuli.

PubMed

Arnaudova, Inna; Krypotos, Angelos-Miltiadis; Effting, Marieke; Kindt, Merel; Beckers, Tom

2017-09-01

Individual differences in fear generalisation have been proposed to play a role in the aetiology and/or maintenance of anxiety disorders, but few data are available to directly support that claim. The research that is available has focused mostly on generalisation of peripheral and central physiological fear responses. Far less is known about the generalisation of avoidance, the behavioural component of fear. In two experiments, we evaluated how neuroticism, a known vulnerability factor for anxiety, modulates an array of fear responses, including avoidance tendencies, towards generalisation stimuli (GS). Participants underwent differential fear conditioning, in which one conditioned stimulus (CS+) was repeatedly paired with an aversive outcome (shock; unconditioned stimulus, US), whereas another was not (CS-). Fear generalisation was observed across measures in Experiment 1 (US expectancy and evaluative ratings) and Experiment 2 (US expectancy, evaluative ratings, skin conductance, startle responses, safety behaviours), with overall highest responding to the CS+, lowest to the CS- and intermediate responding to the GSs. Neuroticism had very little impact on fear generalisation (but did affect GS recognition rates in Experiment 1), in line with the idea that fear generalisation is largely an adaptive process.

Stranger Fear and Early Risk for Social Anxiety in Preschoolers with Fragile X Syndrome Contrasted to Autism Spectrum Disorder.

PubMed

Scherr, Jessica F; Hogan, Abigail L; Hatton, Deborah; Roberts, Jane E

2017-12-01

This study investigated behavioral indicators of social fear in preschool boys with fragile X syndrome (FXS) with a low degree of autism spectrum disorder (ASD) symptoms (FXS-Low; n = 29), FXS with elevated ASD symptoms (FXS-High; n = 25), idiopathic ASD (iASD; n = 11), and typical development (TD; n = 36). Gaze avoidance, escape behaviors, and facial fear during a stranger approach were coded. Boys with elevated ASD symptoms displayed more avoidant gaze, looking less at the stranger and parent than those with low ASD symptoms across etiologies. The iASD group displayed more facial fear than the other groups. Results suggest etiologically distinct behavioral patterns of social fear in preschoolers with elevated ASD symptoms.

The eccentric, concentric strength relationship of the hamstring muscles in chronic low back pain.

PubMed

Marshall, Paul W M; Mannion, Jamie; Murphy, Bernadette A

2010-02-01

The objective of this study was to measure hamstring muscle eccentric and concentric strength in individuals with and without low back pain (LBP). Two composite scores for the relative balance of eccentric to concentric strength at the different movement velocities were calculated (the DEC and SEC), to determine whether or not self perceived pain, disability, or fear avoidance measures were associated with hamstring strength characteristics. Cross-sectional repeated measures design. University laboratory. Fifteen individuals with chronic LBP and 15 matched controls. Isokinetic eccentric and concentric strength at 30 degrees s(-1) and 120 degrees s(-1)(.) Composite scores (DEC and SEC) based on peak torque were calculated to evaluate the relationship between the different muscle actions across the test velocities. Self report measures included the Oswestry disability index, general health and well being, fear avoidance, and pain. Eccentric/concentric strength ratio at 30 degrees s(-1) was higher for the LBP group (F(1,58)=4.81, p=0.032). The SEC was also higher for the LBP (F(1,58)=5.97, p=0.018). Fear avoidance beliefs and mental well-being were significantly associated with the SEC only in the LBP group (adjusted r(2)=0.26, (F(2,27)=5.8, p=.008). For the control group both the DEC and SEC were associated with self report measures. Matched differences between groups' for the SEC were best explained by fear avoidance beliefs about work (adjusted r(2)=0.12, F(1,28)=5.1, p=0.03). Reduced concentric relative to eccentric strength is best identified by the SEC. The SEC was significantly associated with impaired self report measures of fear avoidance and mental well being in individuals with LBP. Differences between groups for the SEC were best explained by fear avoidance beliefs about work.

In the absence of a "landscape of fear": How lions, hyenas, and cheetahs coexist.

PubMed

Swanson, Alexandra; Arnold, Todd; Kosmala, Margaret; Forester, James; Packer, Craig

2016-12-01

Aggression by top predators can create a "landscape of fear" in which subordinate predators restrict their activity to low-risk areas or times of day. At large spatial or temporal scales, this can result in the costly loss of access to resources. However, fine-scale reactive avoidance may minimize the risk of aggressive encounters for subordinate predators while maintaining access to resources, thereby providing a mechanism for coexistence. We investigated fine-scale spatiotemporal avoidance in a guild of African predators characterized by intense interference competition. Vulnerable to food stealing and direct killing, cheetahs are expected to avoid both larger predators; hyenas are expected to avoid lions. We deployed a grid of 225 camera traps across 1,125 km 2 in Serengeti National Park, Tanzania, to evaluate concurrent patterns of habitat use by lions, hyenas, cheetahs, and their primary prey. We used hurdle models to evaluate whether smaller species avoided areas preferred by larger species, and we used time-to-event models to evaluate fine-scale temporal avoidance in the hours immediately surrounding top predator activity. We found no evidence of long-term displacement of subordinate species, even at fine spatial scales. Instead, hyenas and cheetahs were positively associated with lions except in areas with exceptionally high lion use. Hyenas and lions appeared to actively track each, while cheetahs appear to maintain long-term access to sites with high lion use by actively avoiding those areas just in the hours immediately following lion activity. Our results suggest that cheetahs are able to use patches of preferred habitat by avoiding lions on a moment-to-moment basis. Such fine-scale temporal avoidance is likely to be less costly than long-term avoidance of preferred areas: This may help explain why cheetahs are able to coexist with lions despite high rates of lion-inflicted mortality, and highlights reactive avoidance as a general mechanism for predator coexistence.

Prior Learning of Relevant Nonaversive Information Is a Boundary Condition for Avoidance Memory Reconsolidation in the Rat Hippocampus.

PubMed

Radiske, Andressa; Gonzalez, Maria Carolina; Conde-Ocazionez, Sergio A; Feitosa, Anatildes; Köhler, Cristiano A; Bevilaqua, Lia R; Cammarota, Martín

2017-10-04

Reactivated memories can be modified during reconsolidation, making this process a potential therapeutic target for posttraumatic stress disorder (PTSD), a mental illness characterized by the recurring avoidance of situations that evoke trauma-related fears. However, avoidance memory reconsolidation depends on a set of still loosely defined boundary conditions, limiting the translational value of basic research. In particular, the involvement of the hippocampus in fear-motivated avoidance memory reconsolidation remains controversial. Combining behavioral and electrophysiological analyses in male Wistar rats, we found that previous learning of relevant nonaversive information is essential to elicit the participation of the hippocampus in avoidance memory reconsolidation, which is associated with an increase in theta- and gamma-oscillation power and cross-frequency coupling in dorsal CA1 during reactivation of the avoidance response. Our results indicate that the hippocampus is involved in memory reconsolidation only when reactivation results in contradictory representations regarding the consequences of avoidance and suggest that robust nesting of hippocampal theta-gamma rhythms at the time of retrieval is a specific reconsolidation marker. SIGNIFICANCE STATEMENT Posttraumatic stress disorder (PTSD) is characterized by maladaptive avoidance responses to stimuli or behaviors that represent or bear resemblance to some aspect of a traumatic experience. Disruption of reconsolidation, the process by which reactivated memories become susceptible to modifications, is a promising approach for treating PTSD patients. However, much of what is known about fear-motivated avoidance memory reconsolidation derives from studies based on fear conditioning instead of avoidance-learning paradigms. Using a step-down inhibitory avoidance task in rats, we found that the hippocampus is involved in memory reconsolidation only when the animals acquired the avoidance response in an environment that they had previously learned as safe and showed that increased theta- and gamma-oscillation coupling during reactivation is an electrophysiological signature of this process. Copyright © 2017 the authors 0270-6474/17/379675-11$15.00/0.

Validation of the Social Exercise and Anxiety Measure (SEAM): Assessing fears, avoidance, and importance of social exercise

PubMed Central

Levinson, Cheri A.; Rodebaugh, Thomas L.; Menatti, Andrew R.; Weeks, Justin W.

2012-01-01

In two studies (N = 416; N = 118) examining responses from undergraduates, we developed the Social Exercise and Anxiety Measure (SEAM) and tested its factorial, convergent, and divergent validity. Our results demonstrate that the SEAM exhibits an excellent three factor structure consisting of the following subscales: Social Exercise Self-efficacy, Gym Avoidance, and Exercise Importance. In both studies, Social Exercise Self-efficacy correlated negatively and Gym Avoidance correlated positively with social interaction anxiety, fear of scrutiny, and fear of negative evaluation. Exercise Importance correlated positively with frequency of exercise and frequency of public exercise. Implications for the mental and physical health of individuals with high levels of social anxiety are discussed. PMID:24244069

Modifying beliefs about back pain: A pilot study among healthcare professionals.

PubMed

Monnin, Dominique; Courvoisier, Delphine S; Genevay, Stéphane

2016-04-01

This study aimed to explore whether a preventive intervention based on the non-injury model and the biopsychosocial model of back pain succeeded in shifting beliefs toward less negative representations and in decreasing fear-avoidance beliefs related to back pain. One hundred and one healthcare professionals took part in a 10-h educational program held over 2 consecutive days, based on the key messages of the "Back Book." Baseline values were measured 6 weeks before the intervention and when it started. Follow-up was performed at the end of the intervention and six months later. No significant changes were observed between baseline values and values measured at the beginning of the intervention, but participants' beliefs about LBP changed significantly after the program. The benefit remained at 6 months follow-up. A prevention program based on the non-injury and bio-psychosocial models of LBP, introducing empowerment and problem-solving strategies, significantly reduced fear-avoidance and negative beliefs about LBP. The change was clinically relevant and thus could decrease direct and indirect healthcare costs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Effects of the beta-blocker propranolol on cued and contextual fear conditioning in humans.

PubMed

Grillon, Christian; Cordova, Jeremy; Morgan, Charles Andrew; Charney, Dennis S; Davis, Michael

2004-09-01

Beta-adrenergic receptors are involved in the consolidation of emotional memories. Yet, a number of studies using Pavlovian cued fear conditioning have been unable to demonstrate an effect of beta-adrenergic blockade on acquisition or retention of fear conditioning. Evidence for the involvement of beta-adrenergic receptors in emotional memories comes mostly from studies using fear inhibitory avoidance in rodents. It is possible that fear inhibitory avoidance is more akin to contextual conditioning than to cued fear conditioning, suggesting that context conditioning may be disrupted by beta-adrenergic blockade. This study investigated the effects of the beta-adrenergic blocker propranolol on cued and contextual fear conditioning in humans. Subjects were given either placebo (n=15) or 40 mg propranolol (n=15) prior to differential cued conditioning. A week later, they were tested for retention of context and cued fear conditioning using physiological (startle reflex and electrodermal activity) and subjective measures of emotional arousal. The results were consistent with the hypothesis. The skin conductance level (SCL) and the subjective measure of arousal suggested reduced emotional arousal upon returning to the conditioning context in the propranolol group, compared to the placebo group. The acquisition and retention of cued fear conditioning were not affected by propranolol. These results suggest that beta-adrenergic receptors are involved in contextual fear conditioning.

Dutch version of the Fear of Pain Questionnaire for adolescents with chronic pain.

PubMed

Dekker, Carolien; Bastiaenen, Caroline H G; de Vries, Janneke E; Simons, Laura E; Goossens, Mariëlle E J B; Verbunt, Jeanine A M C F

2018-06-01

Fear of pain is important in the development and maintenance of chronic pain. The Fear of Pain Questionnaire-Child version has been developed to assess pain related fear in children and adolescents. Translating the original questionnaire into Dutch, and investigating internal consistency and construct validity to enable use in the Dutch pain rehabilitation setting for treatment and research. Cross-sectional validation study: After forward and back translation of the FOPQ-C, adolescents (11-22 years old) with chronic musculoskeletal pain completed an assessment containing the Dutch Fear of Pain Questionnaire, and questionnaires about demographics, pain catastrophizing, functional disability, and pain intensity. Internal consistency and construct validity were evaluated through exploratory factor analysis (principal axis factoring with oblique rotation) and hypotheses testing using pain catastrophizing, functional disability, and pain intensity as comparative constructs. Eighty-six adolescents completed the assessment. Exploratory factor analysis resulted in a two-factor structure, explaining 43% of the variance. Internal consistency was strong (Cronbach's α = 0.92 total scale, α = 0.88 factor 1, and α = .86 factor 2). Five out of 6 hypotheses were confirmed. The Dutch version demonstrated good internal consistency and good construct validity in a population of adolescents with chronic musculoskeletal pain. Implications for rehabilitation The Fear of Pain Questionnaire-Child version was developed to measure fear of pain and avoidance in children and adolescents with chronic pain. Identification of fear of pain and activities that are being avoided are important during screening and assessment of the adolescent for chronic pain rehabilitation treatment. The presence of fear of pain and/or avoidance behavior is important information to shape and target multidisciplinary rehabilitation treatment.

Fear of childbirth: mothers' experiences of team-midwifery care - a follow-up study.

PubMed

Lyberg, Anne; Severinsson, Elisabeth

2010-05-01

The aim of this study was to illuminate mothers' fear of childbirth and their experiences of the team-midwifery care model during pregnancy, childbirth and the postnatal period. Maternal anxiety and fear of childbirth lead to emotional suffering and affected women's well-being. A previous negative experience of childbirth may result in postnatal depression or avoidance of future pregnancies. This hermeneutic study comprised interviews with 13 women, which were audio-taped and transcribed verbatim, after which interpretative content analysis was performed. Ethical approval was granted. The findings revealed one main theme: The woman's right to ownership of the pregnancy, childbirth and postnatal care as a means of maintaining dignity and three themes; Being aware of barriers and reasons for fear; Being prepared for childbirth and Being confirmed and treated with dignity by the midwife. Each theme contained several sub-themes. The findings contribute insights into how midwives can be educated to reduce fear of childbirth and promote positive birth experiences, despite the existence of negative memories of previous births. In order to achieve continuity and a trusting relationship it is necessary to organise leadership and to adopt models that are flexible and support women's health.

Molecular mechanisms of D-cycloserine in facilitating fear extinction: insights from RNAseq.

PubMed

Malan-Müller, Stefanie; Fairbairn, Lorren; Daniels, Willie M U; Dashti, Mahjoubeh Jalali Sefid; Oakeley, Edward J; Altorfer, Marc; Kidd, Martin; Seedat, Soraya; Gamieldien, Junaid; Hemmings, Sîan Megan Joanna

2016-02-01

D-cycloserine (DCS) has been shown to be effective in facilitating fear extinction in animal and human studies, however the precise mechanisms whereby the co-administration of DCS and behavioural fear extinction reduce fear are still unclear. This study investigated the molecular mechanisms of intrahippocampally administered D-cycloserine in facilitating fear extinction in a contextual fear conditioning animal model. Male Sprague Dawley rats (n = 120) were grouped into four experimental groups (n = 30) based on fear conditioning and intrahippocampal administration of either DCS or saline. The light/dark avoidance test was used to differentiate maladapted (MA) (anxious) from well-adapted (WA) (not anxious) subgroups. RNA extracted from the left dorsal hippocampus was used for RNA sequencing and gene expression data was compared between six fear-conditioned + saline MA (FEAR + SALINE MA) and six fear-conditioned + DCS WA (FEAR + DCS WA) animals. Of the 424 significantly downregulated and 25 significantly upregulated genes identified in the FEAR + DCS WA group compared to the FEAR + SALINE MA group, 121 downregulated and nine upregulated genes were predicted to be relevant to fear conditioning and anxiety and stress-related disorders. The majority of downregulated genes transcribed immune, proinflammatory and oxidative stress systems molecules. These molecules mediate neuroinflammation and cause neuronal damage. DCS also regulated genes involved in learning and memory processes, and genes associated with anxiety, stress-related disorders and co-occurring diseases (e.g., cardiovascular diseases, digestive system diseases and nervous system diseases). Identifying the molecular underpinnings of DCS-mediated fear extinction brings us closer to understanding the process of fear extinction.

Feasibility and Safety of a Virtual Reality Dodgeball Intervention for Chronic Low Back Pain: A Randomized Clinical Trial

PubMed Central

Thomas, James S.; France, Christopher R.; Applegate, Megan E.; Leitkam, Samuel T.; Walkowski, Stevan

2016-01-01

Whereas the fear-avoidance model of chronic low back pain (CLBP) posits a generic avoidance of movement that is perceived as threatening, we have repeatedly shown that individuals with high fear and CLBP specifically avoid flexion of the lumbar spine. Accordingly, we developed a virtual dodgeball intervention designed to elicit graded increases in lumbar spine flexion while reducing expectations of fear and harm by engaging participants in a competitive game that is both entertaining and distracting. We recruited 52 participants (48% female) with CLBP and high fear of movement and randomized them to either a game group (n=26) or a control group (n=26). All participants completed a pregame baseline and a follow up assessment (4–6 days later) of lumbar spine motion and expectations of pain and harm during standardized reaches to high (easier), middle, and low (hardest to reach) targets. For three consecutive days, participants in the game group completed 15 minutes of virtual dodgeball between baseline and follow up. For the standardized reaching tests, there were no significant effects of group on changes in lumbar spine flexion, expected pain, or expected harm. However, virtual dodgeball was effective at increasing lumbar flexion within and across gameplay sessions. Participants reported strong positive endorsement of the game, no increases in medication use, pain, or disability, and no adverse events. Although these findings indicate that very brief exposure to this game did not translate to significant changes outside the game environment, this was not surprising given that graded exposure therapy for fear of movement among individuals with low back pain typically last 8–12 sessions. Given the demonstration of safety, feasibility and ability to encourage lumbar flexion within gameplay, these findings provide support for a clinical trial wherein the treatment dose is more consistent with traditional graded-exposure approaches to CLBP. PMID:27616607

Comparison of Motive to Succeed, Motive to Avoid Failure, and Fear of Success Levels between Male and Female Intercollegiate Swimmers.

ERIC Educational Resources Information Center

Houseworth, Steven; Thirer, Joel

A study investigated sex based differences among intercollegiate athletes for the variables: motive to succeed (Ms), motive to avoid failure (Maf), and fear of success (FOS). Actual athletic competitions were used as target situations to elicit feelings of Ms, Maf, and FOS within each athlete. Mehrabian's scale of achieving tendencies, Martens'…

Feasibility and Safety of a Virtual Reality Dodgeball Intervention for Chronic Low Back Pain: A Randomized Clinical Trial.

PubMed

Thomas, James S; France, Christopher R; Applegate, Megan E; Leitkam, Samuel T; Walkowski, Stevan

2016-12-01

Whereas the fear-avoidance model of chronic low back pain (CLBP) posits a generic avoidance of movement that is perceived as threatening, we have repeatedly shown that individuals with high fear and CLBP specifically avoid flexion of the lumbar spine. Accordingly, we developed a virtual dodgeball intervention designed to elicit graded increases in lumbar spine flexion while reducing expectations of fear and harm by engaging participants in a competitive game that is entertaining and distracting. We recruited 52 participants (48% female) with CLBP and high fear of movement and randomized them to either a game group (n = 26) or a control group (n = 26). All participants completed a pregame baseline and a follow-up assessment (4-6 days later) of lumbar spine motion and expectations of pain and harm during standardized reaches to high (easier), middle, and low (hardest to reach) targets. For 3 consecutive days, participants in the game group completed 15 minutes of virtual dodgeball between baseline and follow-up. For the standardized reaching tests, there were no significant effects of group on changes in lumbar spine flexion, expected pain, or expected harm. However, virtual dodgeball was effective at increasing lumbar flexion within and across gameplay sessions. Participants reported strong positive endorsement of the game, no increases in medication use, pain, or disability, and no adverse events. Although these findings indicate that very brief exposure to this game did not translate to significant changes outside the game environment, this was not surprising because graded exposure therapy for fear of movement among individuals with low back pain typically last 8 to 12 sessions. Because of the demonstration of safety, feasibility, and ability to encourage lumbar flexion within gameplay, these findings provide support for a clinical trial wherein the treatment dose is more consistent with traditional graded exposure approaches to CLBP. This study of a virtual reality dodgeball intervention provides evidence of feasibility, safety, and utility to encourage lumbar spine flexion among individuals with CLBP and high fear of movement. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

The usefulness of olfactory fear conditioning for the study of early emotional and cognitive impairment in reserpine model.

PubMed

Souza, Rimenez R; França, Sanmara L; Bessa, Marília M; Takahashi, Reinaldo N

2013-11-01

Due to the ability for depleting neuronal storages of monoamines, the reserpine model is a suitable approach for the investigation of the neurobiology of neurodegenerative diseases. However, the behavioral effects of low doses of reserpine are not always detected by classic animal tests of cognition, emotion, and sensory ability. In this study, the effects of reserpine (0.5-1.0mg/kg) were evaluated in olfactory fear conditioning, inhibitory avoidance, open-field, elevated plus-maze, and olfactory discrimination. Possible protective effects were also investigated. We found that single administration of reserpine impaired the acquisition of olfactory fear conditioning (in both doses) as well as olfactory discrimination (in the higher dose), while no effects were seen in all other tests. Additionally, we demonstrated that prior exposure to environmental enrichment prevented effects of reserpine in animals tested in olfactory fear conditioning. Altogether, these findings suggest that a combined cognitive, emotional and sensory-dependent task would be more sensitive to the effects of the reserpine model. In addition, the present data support the environmental enrichment as an useful approach for the study of resilience mechanisms in neurodegenerative processes. Copyright © 2013 Elsevier B.V. All rights reserved.

HIV/STD Stigmatization Fears as Health Seeking Barriers in China

PubMed Central

Lieber, Eli; Li, Li; Wu, Zunyou; Rotheram-Borus, Mary Jane; Guan, Jihui

2005-01-01

Internationally, stigma prohibits effective HIV/STD identification, prevention, and care. Interviews with 106 persons in an urban center in Eastern China, some know to have engaged in stigmatized risk acts (sex workers, STD clinic patients) and some vulnerable for stigmatization fears to influence health seeking behaviors (market employees, rural-to-urban migrants). Interviews focused on community norms, values, beliefs, and emotional and behavioral reactions to HIV/STD stigmatization related events. Attributions for infection were found to: mark individual's failure to adhere to sexuality norms; define a condition warranting the avoidance of infected persons and dismissal by medical professionals; and promote anticipation of negative emotions (i.e., shame, fear, and embarrassment) and devalued social roles and status. Strategies reported to avoid stigmatization include: avoiding HIV/STD knowledge; avoiding health care professionals, particularly in public settings; and conforming to community norms of shunning those suspected of risky behaviors. Results have direct implications for community marketing campaigns in China. PMID:16374668

Selective attention and avoidance of pain-related stimuli: a dot-probe evaluation in a pain-free population.

PubMed

Roelofs, Jeffrey; Peters, Madelon L; van der Zijden, Marianne; Thielen, Frans G J M; Vlaeyen, Johan W S

2003-08-01

The present study investigated selective attention and avoidance of pain-related stimuli by applying a dot-probe paradigm to healthy university students. The study consisted of 2 successive experiments. The first experiment, a direct replication of a previous study, failed to find evidence for the presence of attentional bias toward pain-related words in highly fearful individuals compared to those who were low in pain-related fear. A second experiment was set up to examine whether avoidance of pain stimuli was influenced by presentation time of word pairs and to investigate the effects of gender on processing pain-related stimuli. The results from the second experiment showed that presentation time of words, fear of pain scores, and gender in isolation or in interaction with each other did not significantly influence attention to and avoidance of pain-related stimuli. Implications of the results are discussed, and directions for future research are provided.

Fear of Intimacy among College Women.

ERIC Educational Resources Information Center

Lutwak, Nita

1985-01-01

Investigated 107 college women's reactions to intimacy-type items on two questionnaires. Conducted follow-up interviews with 31 women who indicated a high fear of intimacy profile, including high resistance to risk taking and strong fear of getting hurt in relationships. Results supported Hendin's contention regarding women who avoid intimate…

A behavioral test of contamination fear in excessive health anxiety.

PubMed

Brady, Robert E; Lohr, Jeffrey M

2014-03-01

Health anxiety is characterized by a preoccupation with the possibility of having a serious health condition or disease. Contemporary conceptualizations of health anxiety have improved in recent years to incorporate a fear of acquiring an illness; however, there is limited experimental data demonstrating the presence of fear of contamination among health anxious individuals. The present study utilized behavior approach tasks (BATs) to examine the degree to which contamination fear is present in elevated health anxiety. Participants were 60 undergraduate students who reported elevated health anxiety, contamination fear, or no anxiety about either health or contamination. Participants completed four BATS from which avoidance, anxiety, and disgust ratings were derived. Health anxious and contamination fearful individuals exhibited a similar degree of avoidance during the BATs. Contamination fearful participants reported significantly more anxiety and disgust relative to the non-anxious controls, but not the health anxious participants. Health anxious participants did not report more anxiety or disgust than the non-anxious participants. The use of an analogue sample may limit the extension of these findings to clinical populations. Additionally, the role of general negative affect could not be reliably determined in the absence of an anxious control group. These findings suggest that contamination fear may be a source of conceptual overlap between health anxiety and other disorders characterized by contamination fear. This highlights the importance of considering contamination fear in excessive health anxiety. Published by Elsevier Ltd.

Attachment styles in patients with avoidant personality disorder compared with social phobia.

PubMed

Eikenaes, Ingeborg; Pedersen, Geir; Wilberg, Theresa

2016-09-01

Avoidant personality disorder (AvPD) and social phobia (SP) are common, closely related conditions. Little is known about the underlying processes related to the social discomfort of subjects with AvPD and SP. Both disorders are associated with interpersonal problems. An attachment perspective may shed light on similarities and differences in close relationships between the disorders. The aim of the study was to compare self-reported attachment styles in patients with AvPD and SP. We expected that patients with AvPD would have more attachment anxiety and avoidance and more often a Fearful attachment style, compared with SP. This is a cross-sectional multisite study of 90 adult patients with AvPD and SP. Patients with AvPD with and without SP (AvPD group) were compared with patients with SP without AvPD (SP group). Patients were assessed using structured diagnostic interviews and self-reporting questionnaires, including Experiences in Close Relationships (ECR). The ECR dimensions, Anxiety and Avoidance, and the new described five factors of the ECR were used. The AvPD group had higher levels of attachment anxiety than the SP group, especially for the sub-factors Anxiety for abandonment and Separation frustration. The diagnostic groups did not differ in levels of avoidance. Anxiety for abandonment was still associated with AvPD after controlling for symptom disorders and the criteria of other personality disorders. A Fearful attachment style was more frequent among patients with AvPD. The results indicate AvPD is associated with more attachment anxiety than SP. Fear of abandonment may play a significant role in the AvPD pathology. This is the first study to compare attachment styles in patients with avoidant personality disorder (AvPD) and social phobia (SP). The AvPD group had higher attachment-related anxiety than the SP group, and anxiety was most pronounced for the fear of abandonment. Fear of abandonment may play an important role in the AvPD pathology. © 2015 The British Psychological Society.

Effect of Exposure to Lithium-Paired or Amphetamine-Paired Saccharin Solution on Open Arm Avoidance in an Elevated Plus Maze

ERIC Educational Resources Information Center

Rana, Shadna A.; Parker, Linda A.

2006-01-01

Recent evidence suggests that drug-induced conditioned taste avoidance may be mediated by conditioned fear (e.g., Parker, 2003). The experiments reported here evaluated the effect of exposure to a drug-paired flavor on open arm exploration in an elevated plus maze (EPM), a measure of fear. When rats were tested on a familiar (trial 2) EPM, but not…

A meta-analysis of fear appeals: implications for effective public health campaigns.

PubMed

Witte, K; Allen, M

2000-10-01

The fear appeal literature is examined in a comprehensive synthesis using meta-analytical techniques. The meta-analysis suggests that strong fear appeals produce high levels of perceived severity and susceptibility, and are more persuasive than low or weak fear appeals. The results also indicate that fear appeals motivate adaptive danger control actions such as message acceptance and maladaptive fear control actions such as defensive avoidance or reactance. It appears that strong fear appeals and high-efficacy messages produce the greatest behavior change, whereas strong fear appeals with low-efficacy messages produce the greatest levels of defensive responses. Future directions and practical implications are provided.

Chronic nicotine differentially alters spontaneous recovery of contextual fear in male and female mice.

PubMed

Tumolo, Jessica M; Kutlu, Munir Gunes; Gould, Thomas J

2018-04-02

Post-traumatic stress disorder (PTSD) is a devastating disorder with symptoms such as flashbacks, hyperarousal, and avoidance of reminders of the traumatic event. Exposure therapy, which attempts to extinguish fear responses, is a commonly used treatment for PTSD but relapse following successful exposure therapy is a frequent problem. In rodents, spontaneous recovery (SR), where extinguished fear responses resurface following extinction treatment, is used as a model of fear relapse. Previous studies from our lab showed that chronic nicotine impaired fear extinction and acute nicotine enhanced SR of contextual fear in adult male mice. In addition, we showed that acute nicotine's effects were specific to SR as acute nicotine did not affect recall of contextual fear conditioning in the absence of extinction. However, effects of chronic nicotine administration on SR are not known. Therefore, in the present study, we investigated if chronic nicotine administration altered SR or recall of contextual fear in adult male and female C57BL/6J mice. Our results showed that chronic nicotine significantly enhanced SR in female mice and significantly decreased SR in males. Chronic nicotine had no effect on recall of contextual fear in males or females. Female sham mice also had significantly less baseline SR than male sham mice. Overall, these results demonstrate sex differences in SR of fear memories and that chronic nicotine modulates these effects on SR but nicotine does not alter recall of contextual fear. Copyright © 2018 Elsevier B.V. All rights reserved.

Subjective fear, interference by threat, and fear associations independently predict fear-related behavior in children.

PubMed

Klein, Anke M; Kleinherenbrink, Annelies V; Simons, Carlijn; de Gier, Erwin; Klein, Steven; Allart, Esther; Bögels, Susan M; Becker, Eni S; Rinck, Mike

2012-09-01

Several information-processing models highlight the independent roles of controlled and automatic processes in explaining fearful behavior. Therefore, we investigated whether direct measures of controlled processes and indirect measures of automatic processes predict unique variance components of children's spider fear-related behavior. Seventy-seven children between 8 and 13 years performed an Affective Priming Task (APT) measuring associative bias, a pictorial version of the Emotional Stroop Task (EST) measuring attentional bias, filled out the Spider Anxiety and Disgust Screening for Children (SADS-C) in order to assess self-perceived fear, and took part in a Behavioral Assessment Test (BAT) to measure avoidance of spiders. The SADS-C, EST, and APT did not correlate with each other. Spider fear-related behavior was best explained by SADS-C, APT, and EST together; they explained 51% of the variance in BAT behavior. No children with clinical levels of spider phobia were tested. The direct and the different indirect measures did no correlate with each other. These results indicate that both direct and indirect measures are useful for predicting unique variance components of fear-related behavior in children. The lack of relations between direct and indirect measures may explain why some earlier studies did not find stronger color-naming interference or stronger fear associations in children with high levels of self-reported fear. It also suggests that children with high levels of spider-fearful behavior have different fear-related associations and display higher interference by spider stimuli than children with non-fearful behavior. Copyright © 2012 Elsevier Ltd. All rights reserved.

Phi Index: A New Metric to Test the Flush Early and Avoid the Rush Hypothesis

PubMed Central

Samia, Diogo S. M.; Blumstein, Daniel T.

2014-01-01

Optimal escape theory states that animals should counterbalance the costs and benefits of flight when escaping from a potential predator. However, in apparent contradiction with this well-established optimality model, birds and mammals generally initiate escape soon after beginning to monitor an approaching threat, a phenomena codified as the “Flush Early and Avoid the Rush” (FEAR) hypothesis. Typically, the FEAR hypothesis is tested using correlational statistics and is supported when there is a strong relationship between the distance at which an individual first responds behaviorally to an approaching predator (alert distance, AD), and its flight initiation distance (the distance at which it flees the approaching predator, FID). However, such correlational statistics are both inadequate to analyze relationships constrained by an envelope (such as that in the AD-FID relationship) and are sensitive to outliers with high leverage, which can lead one to erroneous conclusions. To overcome these statistical concerns we develop the phi index (Φ), a distribution-free metric to evaluate the goodness of fit of a 1∶1 relationship in a constraint envelope (the prediction of the FEAR hypothesis). Using both simulation and empirical data, we conclude that Φ is superior to traditional correlational analyses because it explicitly tests the FEAR prediction, is robust to outliers, and it controls for the disproportionate influence of observations from large predictor values (caused by the constrained envelope in AD-FID relationship). Importantly, by analyzing the empirical data we corroborate the strong effect that alertness has on flight as stated by the FEAR hypothesis. PMID:25405872

Phi index: a new metric to test the flush early and avoid the rush hypothesis.

PubMed

Samia, Diogo S M; Blumstein, Daniel T

2014-01-01

Optimal escape theory states that animals should counterbalance the costs and benefits of flight when escaping from a potential predator. However, in apparent contradiction with this well-established optimality model, birds and mammals generally initiate escape soon after beginning to monitor an approaching threat, a phenomena codified as the "Flush Early and Avoid the Rush" (FEAR) hypothesis. Typically, the FEAR hypothesis is tested using correlational statistics and is supported when there is a strong relationship between the distance at which an individual first responds behaviorally to an approaching predator (alert distance, AD), and its flight initiation distance (the distance at which it flees the approaching predator, FID). However, such correlational statistics are both inadequate to analyze relationships constrained by an envelope (such as that in the AD-FID relationship) and are sensitive to outliers with high leverage, which can lead one to erroneous conclusions. To overcome these statistical concerns we develop the phi index (Φ), a distribution-free metric to evaluate the goodness of fit of a 1:1 relationship in a constraint envelope (the prediction of the FEAR hypothesis). Using both simulation and empirical data, we conclude that Φ is superior to traditional correlational analyses because it explicitly tests the FEAR prediction, is robust to outliers, and it controls for the disproportionate influence of observations from large predictor values (caused by the constrained envelope in AD-FID relationship). Importantly, by analyzing the empirical data we corroborate the strong effect that alertness has on flight as stated by the FEAR hypothesis.

Cognitive-behavioral therapy for women with lifelong vaginismus: process and prognostic factors.

PubMed

ter Kuile, Moniek M; van Lankveld, Jacques J D M; de Groot, Ellen; Melles, Reinhilde; Neffs, Janneke; Zandbergen, Maartje

2007-02-01

Cognitive-behavioral therapy (CBT) seems an effective treatment of lifelong vaginismus, but mechanisms of action have not yet been established. The present study explored whether the effect of CBT for lifelong vaginismus is mediated by changes in fear of penetration and avoidance behavior, which CBT explicitly aims to alter. A second aim of this study was to predict treatment outcome on the basis of pre-treatment variables. Participants with lifelong vaginismus were allocated at random to a 3-months CBT (n=81) or a waiting-list control condition (n=36). Full vaginal penetration with the penis of the partner constituted the primary outcome measure. Change scores in successful 'non-coital penetrative-behavior' and 'fear of coitus' were used to measure the mediating variables. Treatment resulted in an increase of intercourse (outcome), a decrease in fear of coitus, and an enhancement of successful non-coital penetration behavior, compared with no treatment. Outcome (intercourse) was partly mediated by changes in fear of coitus and changes in avoidance behavior. No treatment predictors could be detected in this study sample. It is concluded that techniques such as gradual exposure, aimed at decreasing avoidance behavior and penetration fear, constitute an important avenue of change in the treatment of lifelong vaginismus.

Coping with Fear through Suppression and Avoidance of Threatening Information

ERIC Educational Resources Information Center

Nielsen, Jesper; Shapiro, Stewart

2009-01-01

Fear appeal communications are widely used by social marketers in their efforts to persuade individuals to refrain from engaging in risky behaviors. The present research shows that exposure to a fear appeal can lead to the suppression of concepts semantically related to the threat and bias attentional resources away from threat-relevant…

A Real Fear

ERIC Educational Resources Information Center

Ruffins, Paul

2007-01-01

For years, mainstream thinking about math anxiety assumed that people fear math because they are bad at it. However, a growing body of research shows a much more complicated relationship between math ability and anxiety. It is true that people who fear math have a tendency to avoid math-related classes, which decreases their math competence.…

Specific phobias.

PubMed

Hamm, Alfons O

2009-09-01

Exposure based treatments in which patients are systematically confronted with their feared objects of situations are highly effective in the treatment of specific phobias and produce stable improvement both in reported fear and behavioral avoidance. Exposure in reality is more effective in most cases than exposure in sensu. For situations that are difficult to realize, exposure in virtual environments has become increasingly valuable. Exposure in vivo is clearly superior to pharmacotherapy, although cognitive enhancers have been successfully used recently to increase the effect of exposure therapy. The induction of relaxation is not a necessary precondition for exposure therapy. Rather the current mechanisms of change focus on extinction learning as being the central mechanism both on a cognitive level namely that the feared object is no longer associated with severely threatening consequence but also on an affective level, meaning that feared cue is no longer capable to activate the fear circuit in the brain. Accordingly future diagnostic categorizations of phobic disorders in the DSM-V should rather focus on the pattern of the fear response that needs to be changed than on the eliciting cues or situations that are avoided.

Enhanced Avoidance Habits in Obsessive-Compulsive Disorder

PubMed Central

Gillan, Claire M.; Morein-Zamir, Sharon; Urcelay, Gonzalo P.; Sule, Akeem; Voon, Valerie; Apergis-Schoute, Annemieke M.; Fineberg, Naomi A.; Sahakian, Barbara J.; Robbins, Trevor W.

2014-01-01

Background Obsessive-compulsive disorder (OCD) is a psychiatric condition that typically manifests in compulsive urges to perform irrational or excessive avoidance behaviors. A recent account has suggested that compulsivity in OCD might arise from excessive stimulus-response habit formation, rendering behavior insensitive to goal value. We tested if OCD patients have a bias toward habits using a novel shock avoidance task. To explore how habits, as a putative model of compulsivity, might relate to obsessions and anxiety, we recorded measures of contingency knowledge, explicit fear, and physiological arousal. Methods Twenty-five OCD patients and 25 control subjects completed a shock avoidance task designed to induce habits through overtraining, which were identified using goal-devaluation. The relationship between habitual behavior, erroneous cognitions, and physiological arousal was assessed using behavior, questionnaires, subjective report, and skin conductance responses. Results A devaluation sensitivity test revealed that both groups could inhibit unnecessary behavioral responses before overtraining. Following overtraining, OCD patients showed greater avoidance habits than control subjects. Groups did not differ in conditioned arousal (skin conductance responses) at any stage. Additionally, groups did not differ in contingency knowledge or explicit ratings of shock expectancy following the habit test. Habit responses were associated with a subjective urge to respond. Conclusions These data indicate that OCD patients have a tendency to develop excessive avoidance habits, providing support for a habit account of OCD. Future research is needed to fully characterize the causal role of physiological arousal and explicit fear in habit formation in OCD. PMID:23510580

Experiential Avoidance as a Mediator of Relationships between Cognitions and Hair-Pulling Severity

ERIC Educational Resources Information Center

Norberg, Melissa M.; Wetterneck, Chad T.; Woods, Douglas W.; Conelea, Christine A.

2007-01-01

Cognitive-behavioral models suggest that certain cognitions and beliefs are functionally related to hair pulling in persons with trichotillomania (TTM), but little empirical data have been collected to test such claims. This study assessed dysfunctional beliefs about appearance, shameful cognitions, and fear of negative evaluation and their…

Protection Motivation and Self-Efficacy: Toward a General Expectancy-Value Model of Attitude Change.

ERIC Educational Resources Information Center

Maddux, James E.; Rogers, Ronald W.

Rogers' protection motivation theory that, in a fear-producing situation, stresses cognitive processes rather than emotional ones and emphasizes coping with or avoiding aversive events rather than reducing unpleasant emotional states and Bandura's theory of self-efficacy, i.e., all processes of psychological change operate through the alteration…

Disruptions in Women's Self-Promotion: The Backlash Avoidance Model

ERIC Educational Resources Information Center

Moss-Racusin, Corinne A.; Rudman, Laurie A.

2010-01-01

Women experience social and economic penalties (i.e., backlash) for self-promotion, a behavior that violates female gender stereotypes yet is necessary for professional success. However, it is unknown whether and how the threat of backlash interferes with women's ability to self-promote. The present research examined the effects of fear of…

When scientific paradigms lead to tunnel vision: lessons from the study of fear

NASA Astrophysics Data System (ADS)

Paré, Denis; Quirk, Gregory J.

2017-03-01

For the past 30 years, research on the amygdala has largely focused on the genesis of defensive behaviors as its main function. This focus originated from early lesion studies and was supported by extensive anatomical, physiological, and pharmacological data. Here we argue that while much data is consistent with the fear model of amygdala function, it has never been directly tested, in part due to overreliance on the fear conditioning task. In support of the fear model, amygdala neurons appear to signal threats and/or stimuli predictive of threats. However, recent studies in a natural threat setting show that amygdala activity does not correlate with threats, but simply with the movement of the rat, independent of valence. This was true for both natural threats as well as conditioned stimuli; indeed there was no evidence of threat signaling in amygdala neurons. Similar findings are emerging for prefrontal neurons that modulate the amygdala. These recent developments lead us to propose a new conceptualization of amygdala function whereby the amygdala inhibits behavioral engagement. Moreover, we propose that the goal of understanding the amygdala will be best served by shifting away from fear conditioning toward naturalistic approach and avoidance paradigms that involve decision-making and a larger repertoire of spontaneous and learned behaviors, all the while keeping an open mind.

Exciting fear in adolescence: Does pubertal development alter threat processing?

PubMed Central

Spielberg, Jeffrey M.; Olino, Thomas M.; Forbes, Erika E.; Dahl, Ronald E.

2014-01-01

Adolescent development encompasses an ostensible paradox in threat processing. Risk taking increases dramatically after the onset of puberty, contributing to a 200% increase in mortality. Yet, pubertal maturation is associated with increased reactivity in threat-avoidance systems. In the first part of this paper we propose a heuristic model of adolescent affective development that may help to reconcile aspects of this paradox, which focuses on hypothesized pubertal increases in the capacity to experience (some) fear-evoking experiences as an exciting thrill. In the second part of this paper, we test key features of this model by examining brain activation to threat cues in a longitudinal study that disentangled pubertal and age effects. Pubertal increases in testosterone predicted increased activation to threat cues, not only in regions associated with threat avoidance (i.e., amygdala), but also regions associated with reward pursuit (i.e., nucleus accumbens). These findings are consistent with our hypothesis that puberty is associated with a maturational shift toward more complex processing of threat cues–which may contribute to adolescent tendencies to explore and enjoy some types of risky experiences. PMID:24548554

The Relation Between Death Attitude and Distress: Tolerance, Aggression, and Anger.

PubMed

Esnaashari, Fatemeh; Kargar, Flor Rezaei

2018-06-01

The aim of this research was to determine the relation between death attitude and distress tolerance and aggression and anger. For this, 135 subjects among 7,535 professional and specialist members of the Iran National Library were selected using convenience sampling method. They replied to Death Attitudes Profile-Revised, distress tolerance questionnaire, and aggression questionnaire. The results showed that the attitudes of approach acceptance, neutral acceptance, and escape acceptance had positive relation to distress tolerance and negative relation to aggression and anger while the attitudes of fear of death and death avoidance had negative relation to distress tolerance and positive relation to aggression and anger. Furthermore, all death attitudes predicted distress tolerance. But only the attitudes of approach acceptance, escape acceptance, fear of death, and death avoidance predicted aggression, and only approach acceptance, neutral acceptance, fear of death, and death avoidance predicted anger.

Patient clusters in acute, work-related back pain based on patterns of disability risk factors.

PubMed

Shaw, William S; Pransky, Glenn; Patterson, William; Linton, Steven J; Winters, Thomas

2007-02-01

To identify subgroups of patients with work-related back pain based on disability risk factors. Patients with work-related back pain (N = 528) completed a 16-item questionnaire of potential disability risk factors before their initial medical evaluation. Outcomes of pain, functional limitation, and work disability were assessed 1 and 3 months later. A K-Means cluster analysis of 5 disability risk factors (pain, depressed mood, fear avoidant beliefs, work inflexibility, and poor expectations for recovery) resulted in 4 sub-groups: low risk (n = 182); emotional distress (n = 103); severe pain/fear avoidant (n = 102); and concerns about job accommodation (n = 141). Pain and disability outcomes at follow-up were superior in the low-risk group and poorest in the severe pain/fear avoidant group. Patients with acute back pain can be discriminated into subgroups depending on whether disability is related to pain beliefs, emotional distress, or workplace concerns.

Cognitive models for panic disorder with agoraphobia: A study of disaggregated within-person effects.

PubMed

Hoffart, Asle

2016-09-01

The purpose of this study was to test 2 cognitive models of panic disorder with agoraphobia (PDA)-a catastrophic cognitions model and a low self-efficacy model-by examining the within-person effects of model-derived cognitive variables on subsequent anxiety symptoms. Participants were 46 PDA patients with agoraphobic avoidance of moderate to severe degree who were randomly allocated to 6 weeks of either cognitive therapy, based on the catastrophic cognitions model of PDA, or guided mastery (guided exposure) therapy, based on the self-efficacy model of PDA. Cognitions and anxiety were measured weekly over the course of treatment. The data were analyzed with mixed models, using person-mean centering to disaggregate within- and between-person effects. All of the studied variables changed in the expected way over the course of therapy. There was a within-person effect of physical fears, loss of control fears, social fears, and self-efficacy when alone on subsequent state anxiety. On the other hand, within-person changes in anxiety did not predict subsequent cognitions. Loss of control and social fears both predicted subsequent self-efficacy, whereas self-efficacy did not predict catastrophic cognitions. In a multipredictor analysis, within-person catastrophic cognitions still predicted subsequent anxiety, but self-efficacy when alone did not. Overall, the findings indicate that anxiety in PDA, at least in severe and long-standing cases, is driven by catastrophic cognitions. Thus, these cognitions seem to be useful therapeutic targets. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Gender moderates the associations between attachment and discrete emotions in late middle age and later life.

PubMed

Consedine, Nathan S; Fiori, Katherine L

2009-11-01

Although patterns of attachment have been linked to patterns of emotional experience, studies in developmentally diverse samples are few and have not yet examined possible gender differences in attachment or their implications for emotional wellbeing. This article describes patterns of attachment in a diverse sample of 616 men and women from middle age and later life, examines the relations between attachment and nine discrete emotions, and tests the thesis that gender moderates these associations. Convenience sampling was used to derive a sample of 616 ethnically diverse men and women from seven ethnic groups. Multiple regressions controlling for demographics found no gender differences in attachment categorizations although men reported greater dimensional fearful avoidance. Security predicted greater joy and interest whereas dismissingness was associated with lower shame and fear and with greater interest. Both preoccupation and fearful avoidance predicted most negative emotions but were not associated with positive emotions. Finally, gender moderated these associations such that (a) attachment security was more closely related to interest and, marginally, joy, among men; (b) fearful avoidance was more closely related to fear and contempt among men; and (c) preoccupation was associated with greater interest among men, whereas fear and contempt were associated with preoccupation among women only. Interpreted in the context of theories of emotions, the social origins of emotional experience, and the different roles that social relationships have for aging men and women, our data imply that attachment styles may differentially predict male emotions because of their less diverse networks.

Appraisal and coping styles account for the effects of temperament on preadolescent adjustment

PubMed Central

Thompson, Stephanie F.; Zalewski, Maureen; Lengua, Liliana J.

2014-01-01

Temperament, appraisal, and coping are known to underlie emotion regulation, yet less is known about how these processes relate to each other across time. We examined temperamental fear, frustration, effortful control, and impulsivity, positive and threat appraisals, and active and avoidant coping as processes underpinning the emotion regulation of pre-adolescent children managing stressful events. Appraisal and coping styles were tested as mediators of the longitudinal effects of temperamental emotionality and self-regulation on adjustment using a community sample (N=316) of preadolescent children (8–12 years at T1) studied across one year. High threat appraisals were concurrently related to high fear and impulsivity, whereas effortful control predicted relative decreases in threat appraisal. High fear was concurrently related to high positive appraisal, and impulsivity predicted increases in positive appraisal. Fear was concurrently related to greater avoidant coping, and impulsivity predicted increases in avoidance. Frustration predicted decreases in active coping. These findings suggest temperament, or dispositional aspects of reactivity and regulation, relates to concurrent appraisal and coping processes and additionally predicts change in these processes. Significant indirect effects indicated that appraisal and coping mediated the effects of temperament on adjustment. Threat appraisal mediated the effects of fear and effortful control on internalizing and externalizing problems, and avoidant coping mediated the effect of impulsivity on internalizing problems. These mediated effects suggest that one pathway through which temperament influences adjustment is pre-adolescents’ appraisal and coping. Findings highlight temperament, appraisal and coping as emotion regulation processes relevant to children’s adjustment in response to stress. PMID:25821237

Modeling Avoidance in Mood and Anxiety Disorders Using Reinforcement Learning.

PubMed

Mkrtchian, Anahit; Aylward, Jessica; Dayan, Peter; Roiser, Jonathan P; Robinson, Oliver J

2017-10-01

Serious and debilitating symptoms of anxiety are the most common mental health problem worldwide, accounting for around 5% of all adult years lived with disability in the developed world. Avoidance behavior-avoiding social situations for fear of embarrassment, for instance-is a core feature of such anxiety. However, as for many other psychiatric symptoms the biological mechanisms underlying avoidance remain unclear. Reinforcement learning models provide formal and testable characterizations of the mechanisms of decision making; here, we examine avoidance in these terms. A total of 101 healthy participants and individuals with mood and anxiety disorders completed an approach-avoidance go/no-go task under stress induced by threat of unpredictable shock. We show an increased reliance in the mood and anxiety group on a parameter of our reinforcement learning model that characterizes a prepotent (pavlovian) bias to withhold responding in the face of negative outcomes. This was particularly the case when the mood and anxiety group was under stress. This formal description of avoidance within the reinforcement learning framework provides a new means of linking clinical symptoms with biophysically plausible models of neural circuitry and, as such, takes us closer to a mechanistic understanding of mood and anxiety disorders. Copyright © 2017 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Mouse social stress induces increased fear conditioning, helplessness and fatigue to physical challenge together with markers of altered immune and dopamine function.

PubMed

Azzinnari, Damiano; Sigrist, Hannes; Staehli, Simon; Palme, Rupert; Hildebrandt, Tobias; Leparc, German; Hengerer, Bastian; Seifritz, Erich; Pryce, Christopher R

2014-10-01

In neuropsychiatry, animal studies demonstrating causal effects of environmental manipulations relevant to human aetiology on behaviours relevant to human psychopathologies are valuable. Such valid models can improve understanding of aetio-pathophysiology and preclinical discovery and development of new treatments. In depression, specific uncontrollable stressful life events are major aetiological factors, and subsequent generalized increases in fearfulness, helplessness and fatigue are core symptoms or features. Here we exposed adult male C57BL/6 mice to 15-day psychosocial stress with loss of social control but minimal physical wounding. One cohort was assessed in a 3-day test paradigm of motor activity, fear conditioning and 2-way avoid-escape behaviour on days 16-18, and a second cohort was assessed in a treadmill fatigue paradigm on days 19 and 29, followed by the 3-day paradigm on days 30-32. All tests used a physical aversive stimulus, namely mild, brief electroshocks. Socially stressed mice displayed decreased motor activity, increased fear acquisition, decreased 2-way avoid-escape responding (increased helplessness) and increased fatigue. They also displayed increased plasma TNF and spleen hypertrophy, and adrenal hypertrophy without hyper-corticoidism. In a third cohort, psychosocial stress effects on brain gene expression were assessed using next generation sequencing. Gene expression was altered in pathways of inflammation and G-protein coupled receptors in prefrontal cortex and amygdala; in the latter, expression of genes important in dopamine function were de-regulated including down-regulated Drd2, Adora2a and Darpp-32. This model can be applied to identify targets for treating psychopathologies such as helplessness or fatigue, and to screen compounds/biologics developed to act at these targets. Copyright © 2014 Elsevier Ltd. All rights reserved.

Fear Appeals, Engagement, and Examination Performance: The Role of Challenge and Threat Appraisals

ERIC Educational Resources Information Center

Putwain, David W.; Symes, Wendy; Wilkinson, Hannah M.

2017-01-01

Background: Fear appeals are persuasive messages that draw attention to the negative consequences (e.g., academic failure) that follow a particular course of action (e.g., not engaging in lessons) and how negative consequences can be avoided with an alternate course of action. Previous studies have shown that when fear appeals are appraised as…

Exposure to Novelty Weakens Conditioned Fear in Long-Evans Rats

ERIC Educational Resources Information Center

Anderson, Matthew J.; Burpee, Tara E.; Wall, Matthew J.; McGraw, Justin J.

2013-01-01

The present study sought to determine whether post-training exposure to a novel or familiar object, encountered in either the location of the original fear conditioning (black compartment of a passive avoidance {PA} chamber) or in a neutral setting (open field where initial object training had occurred) would prove capable of reducing fear at…

Telepsychology and Self-Help: The Treatment of Fear of Public Speaking

ERIC Educational Resources Information Center

Botella, Cristina; Guillen, Veronica; Banos, Rosa M.; Garcia-Palacios, Azucena; Gallego, Maria J.; Alcaniz, Mariano

2007-01-01

This work presents a self-help, Internet-based telepsychology program for the treatment of public speaking fears. The system is comprised of 3 parts: The "assessment protocol" gives the patient information about his or her problem (i.e., amount of interference it creates in his or her life, severity, degree of fear and avoidance). The…

Romantic Attachment and Subtypes/Dimensions of Jealousy

PubMed Central

Marazziti, Donatella; Consoli, Giorgio; Albanese, Francesco; Laquidara, Emanuela; Baroni, Stefano; Catena Dell’Osso, Mario

2010-01-01

The present study explored the possible relationship between romantic attachment and jealousy in 100 healthy subjects. The romantic attachment and jealousy were evaluated by means of, respectively, the “Experiences in Close Relationships” questionnaire (ECR), and the “Questionario della Gelosia” (QUEGE). The ECR anxiety scale was related to all QUEGE dimensions, while the ECR avoidance scale to three. Individuals with the preoccupied attachment style showed higher scores than secure subjects on the obsessionality, interpersonal sensitivity and fear of loss dimensions. Fearful-avoidant individuals had higher score than secure subjects on the fear of loss dimension only, while dismissing individuals had lower scores on the self-esteem dimension. These findings suggest that romantic attachment and jealousy are intertwined. PMID:20835357

Mastery matters most: How mastery and positive relations link attachment avoidance and anxiety to negative emotions.

PubMed

Paech, Juliane; Schindler, Ines; Fagundes, Christopher P

2016-08-01

Attachment avoidance and anxiety are associated with negative emotions. However, the mechanisms underlying these associations are not fully understood. We investigated environmental mastery and positive relations with others as two mechanisms behind the attachment-emotion link in a sample of 343 adults. As predicted, attachment avoidance and anxiety were related to greater fear, hostility, envy and depression through lower mastery. Contrary to our hypothesis, positive relations mediated only the attachment-depression link. In addition, by adopting a moderated mediation approach, we were able to show that mastery mattered most for individuals high on avoidance: The indirect effect of avoidance through lack of mastery on fear, hostility and depression (but not on envy) increased with higher avoidance scores. Contrary to our predictions, poor relationships did not matter more as sources of negative emotions as anxiety increased. These findings underscore that the emotional life of avoidantly attached individuals is especially jeopardised by poor mastery.

The Role of Self-reports and Behavioral Measures of Interpretation Biases in Children with Varying Levels of Anxiety.

PubMed

Klein, Anke M; Flokstra, Emmelie; van Niekerk, Rianne; Klein, Steven; Rapee, Ronald M; Hudson, Jennifer L; Bögels, Susan M; Becker, Eni S; Rinck, Mike

2018-04-21

We investigated the role of self-reports and behavioral measures of interpretation biases and their content-specificity in children with varying levels of spider fear and/or social anxiety. In total, 141 selected children from a community sample completed an interpretation bias task with scenarios that were related to either spider threat or social threat. Specific interpretation biases were found; only spider-related interpretation bias and self-reported spider fear predicted unique variance in avoidance behavior on the Behavior Avoidance Task for spiders. Likewise, only social-threat related interpretation bias and self-reported social anxiety predicted anxiety during the Social Speech Task. These findings support the hypothesis that fearful children display cognitive biases that are specific to particular fear-relevant stimuli. Clinically, this insight might be used to improve treatments for anxious children by targeting content-specific interpretation biases related to individual disorders.

Coping with the 10th anniversary of 9/11: Muslim Americans' sadness, fear, and anger.

PubMed

Rodriguez Mosquera, Patricia M; Khan, Tasmiha; Selya, Arielle

2013-01-01

The events of 9/11 marked an increase in prejudice, discrimination, and other forms of unfair treatment toward Muslim Americans. We present a study that examined the emotions of Muslim Americans in the days preceding the ten-year 9/11 anniversary. We measured the antecedents (concerns) and consequences (coping) of sadness, fear, and anger. The 9/11 anniversary precipitated intense concerns with loss and discrimination, and intense feelings of sadness, fear, and anger. We measured three coping responses: rumination, avoidance of public places, and religious coping. Participants engaged in all three coping responses, with seeking solace in one's religion being the most frequent response. Moreover, emotions mediated the relationship between concerns and coping responses. Sadness accounted for the association between concern with loss and rumination. Fear explained the association between concern with discrimination and avoidance. Anger accounted for the association between concern with discrimination and religious coping.

Fear of Vomiting and Low Body Weight in Two Pediatric Patients: Diagnostic Challenges.

PubMed

Maertens, Charlotte; Couturier, Jennifer; Grant, Christina; Johnson, Natasha

2017-01-01

Fear of vomiting can be a symptom associated with several disorders, including Eating Disorders (ED), Specific Phobia (Emetophobia), Avoidant Restrictive Food Intake Disorder (ARFID) and Obsessive Compulsive Disorder (OCD), making proper diagnosis challenging. At this time the literature exploring this symptom is limited, and to our knowledge very few cases have been described in the child and adolescent population. We report here the cases of one child and one adolescent presenting with significant weight loss, food restriction and fear of vomiting. The child's fear of vomiting masked a concurrent desire to achieve fitness and weight loss, which was uncovered following weight restoration. The adolescent patient, although significantly underweight and food avoidant, also expressed no concerns with body image, until weight restored. The history, course in hospital and management of these patients is discussed, along with several challenges that complicated the diagnosis.

A longitudinal analysis of posttraumatic stress disorder symptoms and their relationship with Fear and Anxious-Misery disorders: implications for DSM-V.

PubMed

Forbes, David; Parslow, Ruth; Creamer, Mark; O'Donnell, Meaghan; Bryant, Richard; McFarlane, Alexander; Silove, Derrick; Shalev, Arieh

2010-12-01

This paper examined the hypothesis that PTSD-unique symptom clusters of re-experiencing, active avoidance and hyperarousal were more related to the fear/phobic disorders, while shared PTSD symptoms of dysphoria were more closely related to Anxious-Misery disorders (MDD/GAD). Confirmatory factor and correlation analyses examining PTSD, anxiety and mood disorder data from 714 injury survivors interviewed 3, 12 and 24-months following their injury supported this hypothesis with these relationships remaining robust from 3-24 months posttrauma. Of the nine unique fear-oriented PTSD symptoms, only one is currently required for a DSM-IV diagnosis. Increasing emphasis on PTSD fear symptoms in DSM-V, such as proposed DSM-V changes to mandate active avoidance, is critical to improve specificity, ensure inclusion of dimensionally distinct features and facilitate tailoring of treatment. Copyright © 2010 Elsevier B.V. All rights reserved.

Structural Analysis of 1995-2005 School Crime Supplement Datasets: Factors Influencing Students' Fear, Anxiety, and Avoidant Behaviors

ERIC Educational Resources Information Center

Mayer, Matthew J.

2010-01-01

The 1995-2005 School Crime Supplement datasets were analyzed using structural equation modeling. Converging evidence across multiple analyses suggests that secure school building policies may not be systematically linked to school disorder and may be more a reactive measure in response to other concerns. Most importantly, measures of incivility…

Prognostic factors for perceived recovery or functional improvement in non-specific low back pain: secondary analyses of three randomized clinical trials

PubMed Central

Staal, J. Bart; Heymans, Martijn W.; Harts, Chris C.; Hendriks, Erik J. M.; de Bie, Rob A.

2009-01-01

The objective of this study was to report on secondary analyses of a merged trial dataset aimed at exploring the potential importance of patient factors associated with clinically relevant improvements in non-acute, non-specific low back pain (LBP). From 273 predominantly male army workers (mean age 39 ± 10.5 years, range 20–56 years, 4 women) with LBP who were recruited in three randomized clinical trials, baseline individual patient factors, pain-related factors, work-related psychosocial factors, and psychological factors were evaluated as potential prognostic variables in a short-term (post-treatment) and a long-term logistic regression model (6 months after treatment). We found one dominant prognostic factor for improvement directly after treatment as well as 6 months later: baseline functional disability, expressed in Roland–Morris Disability Questionnaire scores. Baseline fear of movement, expressed in Tampa Scale for Kinesiophobia scores, had also significant prognostic value for long-term improvement. Less strongly associated with the outcome, but also included in our final models, were supervisor social support and duration of complaints (short-term model), and co-worker social support and pain radiation (long-term model). Information about initial levels of functional disability and fear-avoidance behaviour can be of value in the treatment of patient populations with characteristics comparable to the current army study population (e.g., predominantly male, physically active, working, moderate but chronic back problems). Individuals at risk for poor long-term LBP recovery, i.e., individuals with high initial level of disability and prominent fear-avoidance behaviour, can be distinguished that may need additional cognitive-behavioural treatment. PMID:20035358

Pain intensity and abdominal muscle activation during walking in patients with low back pain: The STROBE study.

PubMed

Kim, Si-Hyun; Park, Kyue-Nam; Kwon, Oh-Yun

2017-10-01

Nonspecific low back pain (LBP) is a common musculoskeletal problem that is intensified during physical activity. Patients with LBP have been reported to change their abdominal muscle activity during walking; however, the effects of pain intensity, disability level, and fear-avoidance belief on this relationship have not been evaluated. Thus, we compared abdominal muscle activity in patients with LBP and asymptomatic controls, and assessed the impact of pain intensity, disability level, and fear-avoidance belief.Thirty patients with LBP divided into groups reporting low (LLBP) and high-pain intensity low back pain (HLBP), and 15 participants without LBP were recruited. LBP patients' self-reported pain intensity, disability, and fear-avoidance belief were recorded. To examine abdominal muscle activity (rectus abdominis [RA], internal [IO], and external oblique [EO] muscles) during walking, all subjects walked at a self-selected speed. Abdominal muscle activity (RA, IO, and EO) was compared among groups (LLBP, HLBP, and controls) in different phases of walking (double support vs swing). Relationships between abdominal muscle activity and clinical measures (pain intensity, disability, fear-avoidance belief) were analyzed using partial correlation analysis.Right IO muscle activity during walking was significantly decreased in LLBP and HLBP compared with controls in certain walking phase. Partial correlation coefficients showed significant correlations between fear-avoidance belief and right EO activity (r = .377, P < .05) and between disability index and left IO activity (r = .377, P < .05) in patients with LBP. No significant difference was found in abdominal muscle activity in walking between patients with LLBP and HLBP (P > .05).This study demonstrated decreased IO muscle activity during certain walking phases in LLBP and HLBP compared with asymptomatic participants. Although altered IO muscle activity during walking was observed in patients with LBP, no changes were found with other abdominal muscles (EO, RA). Thus, these results provide useful information about abdominal muscle activity during walking in patients with LBP.

D-cycloserine enhances generalization of fear extinction in children.

PubMed

Byrne, Simon P; Rapee, Ronald M; Richardson, Rick; Malhi, Gin S; Jones, Michael; Hudson, Jennifer L

2015-06-01

For exposure therapy to be successful, it is essential that fear extinction learning extends beyond the treatment setting. D-cycloserine (DCS) may facilitate treatment gains by increasing generalization of extinction learning, however, its effects have not been tested in children. We examined whether DCS enhanced generalization of fear extinction learning across different stimuli and contexts among children with specific phobias. The study was a double-blind placebo-controlled randomized controlled trial among dog or spider phobic children aged 6-14. Participants ingested either 50 mg of DCS (n = 18) or placebo (n = 17) before receiving a single prolonged exposure session to their feared stimulus. Return of fear was examined 1 week later to a different stimulus (a different dog or spider), presented in both the original treatment context and an alternate context. Avoidance and fear were measured with Behavior Approach Tests (BATs), where the child was asked to increase proximity to the stimulus while reporting their fear level. There were no differences in BAT performance between groups during the exposure session or when a new stimulus was later presented in the treatment context. However, when the new stimulus was presented in a different context, relative to placebo, the DCS group showed less avoidance (P = .03) and less increase in fear (P = .04) with moderate effect sizes. DCS enabled children to better retain their fear extinction learning. This new learning generalized to different stimuli and contexts. © 2015 Wiley Periodicals, Inc.

The Appraisal of Fear Appeals as Threatening or Challenging: Frequency of Use, Academic Self-Efficacy and Subjective Value

ERIC Educational Resources Information Center

Putwain, David; Remedios, Richard; Symes, Wendy

2016-01-01

Fear appeals are messages that focus on avoiding the negative consequences of failure. They are often used by teachers as a motivational tactic prior to high-stakes examinations. In this study, we examined whether 566 secondary school students, from 26 different classes, approaching high-stakes examinations appraised fear appeals as threatening or…

Adaptation of a paradigm for examining the development of fear beliefs through the verbal information pathway in preschool-age children.

PubMed

Rifkin, Lara S; Schofield, Casey A; Beard, Courtney; Armstrong, Thomas

2016-12-01

Verbal threat information has been shown to induce fear beliefs in school-age children (i.e. 6-12 years; for a review see Muris & Field, 2010). The current study adapted an existing paradigm (Field & Lawson, 2003) to examine the impact of verbal threat information on self-report and behavioral measures of fear in preschool-age children. Thirty children (aged 3-5) were provided with threat, positive, or no information about three novel Australian marsupials. There was a significant increase in fear belief for the animal associated with threat information compared to the animal associated with positive or no information. Verbal threat information did not impact behavioral avoidance in the complete sample; however, findings from an exploratory subgroup analysis excluding three-year-olds indicated that children demonstrated significant behavioral avoidance for the threat condition compared to the positive condition. These findings provide additional support for Rachman's theory of fear acquisition (1977, 1991) and suggest this paradigm may be used to examine the age at which verbal threat information becomes a relevant mode of fear acquisition for young children. Copyright © 2016 Elsevier Ltd. All rights reserved.

Biases in attention, interpretation, memory, and associations in children with varying levels of spider fear: Inter-relations and prediction of behavior.

PubMed

Klein, Anke M; van Niekerk, Rianne; Ten Brink, Giovanni; Rapee, Ronald M; Hudson, Jennifer L; Bögels, Susan M; Becker, Eni S; Rinck, Mike

2017-03-01

Cognitive theories suggest that cognitive biases may be related and together influence the anxiety response. However, little is known about the interrelations of cognitive bias tasks and whether they allow for an improved prediction of fear-related behavior in addition to self-reports. This study simultaneously addressed several types of cognitive biases in children, to investigate attention bias, interpretation bias, memory bias and fear-related associations, their interrelations and the prediction of behavior. Eighty-one children varying in their levels of spider fear completed the Spider Anxiety and Disgust Screening for Children and performed two Emotional Stroop tasks, a Free Recall task, an interpretation task including size and distance indication, an Affective Priming Task, and a Behavioral Assessment Test. We found an attention bias, interpretation bias, and fear-related associations, but no evidence for a memory bias. The biases showed little overlap. Attention bias, interpretation bias, and fear-related associations predicted unique variance in avoidance of spiders. Interpretation bias and fear-related associations remained significant predictors, even when self-reported fear was included as a predictor. Children were not seeking help for their spider fear and were not tested on clinical levels of spider phobia. This is the first study to find evidence that different cognitive biases each predict unique variance in avoidance behavior. Furthermore, it is also the first study in which we found evidence for a relation between fear of spiders and size and distance indication. We showed that this bias is distinct from other cognitive biases. Copyright © 2016 Elsevier Ltd. All rights reserved.

Examining spatial patterns of selection and use for an altered predator guild.

PubMed

Mumma, Matthew A; Holbrook, Joseph D; Rayl, Nathaniel D; Zieminski, Christopher J; Fuller, Todd K; Organ, John F; Mahoney, Shane P; Waits, Lisette P

2017-12-01

Anthropogenic disturbances have altered species' distributions potentially impacting interspecific interactions. Interference competition is when one species denies a competing species access to a resource. One mechanism of interference competition is aggression, which can result in altered space-use of a subordinate species due to the threat of harm, otherwise known as a 'landscape of fear'. Alternatively, subordinates might outcompete dominant species in resource-poor environments via a superior ability to extract resources. Our goal was to evaluate spatial predictions of the 'landscape of fear' hypothesis for a carnivore guild in Newfoundland, Canada, where coyotes recently immigrated. Native Newfoundland carnivores include red foxes, Canada lynx, and black bears. We predicted foxes and lynx would avoid coyotes because of their larger size and similar dietary niches. We used scat-detecting dogs and genetic techniques to locate and identify predator scats. We then built resource selection functions and tested for avoidance by incorporating predicted values of selection for the alternative species into the best supported models of each species. We found multiple negative relationships, but notably did not find avoidance by foxes of areas selected by coyotes. While we did find that lynx avoided coyotes, we also found a reciprocal relationship. The observed patterns suggest spatial partitioning and not coyote avoidance, although avoidance could still be occurring at different spatial or temporal scales. Furthermore, Newfoundland's harsh climate and poor soils may swing the pendulum of interspecific interactions from interference competition to exploitative competition, where subordinates outcompete dominant competitors through a superior ability to extract resources.

Worry and Generalized Anxiety Disorder: A Review and Theoretical Synthesis of Evidence on Nature, Etiology, Mechanisms, and Treatment

PubMed Central

Newman, Michelle G.; Llera, Sandra J.; Erickson, Thane M.; Przeworski, Amy; Castonguay, Louis G.

2016-01-01

Generalized anxiety disorder (GAD) is associated with substantial personal and societal cost yet is the least successfully treated of the anxiety disorders. In this review, research on clinical features, boundary issues, and naturalistic course, as well as risk factors and maintaining mechanisms (cognitive, biological, neural, interpersonal, and developmental), are presented. A synthesis of these data points to a central role of emotional hyperreactivity, sensitivity to contrasting emotions, and dysfunctional attempts to cope with strong emotional shifts via worry. Consistent with the Contrast Avoidance model, evidence shows that worry evokes and sustains negative affect, thereby precluding sharp increases in negative emotion. We also review current treatment paradigms and suggest how the Contrast Avoidance model may help to target key fears and avoidance tendencies that serve to maintain pathology in GAD. PMID:23537486

Amygdala kindling-resistant (SLOW) or -prone (FAST) rat strains show differential fear responses.

PubMed

Mohapel, P; McIntyre, D C

1998-12-01

The authors compared two rat strains, selectively bred for their susceptibility to amygdala kindling, with respect to their performance on various behavioral and learning tasks that are associated with fear and anxiety. The two rat strains differed significantly in measurements of exploration of novel and familiar environments, as well as in reactivity to footshock and fear-based learning. The kindling-resistant (SLOW) strain exhibited a lower ratio of open- to closed-arm entries in the elevated plus-maze, less activity over days in the open field, greater behavioral suppression in the open-field if previously footshocked, greater freezing in the inhibitory avoidance task, and slower acquisition and poorer retention in the one-way avoidance task than did the kindling-prone (FAST) strain. These experiments suggest that the SLOW rats are more expressively fearful than the FAST rats, particularly with respect to environmentally triggered freezing or immobility. Further, these observations imply that the relatively constrained excitability of the amygdala network in the SLOW rats might mediate their relatively greater expression of fear and anxiety compared with the FAST rats.

The Liebowitz Social Anxiety Scale for Children and Adolescents.

PubMed

Olivares, José; Sánchez-García, Raquel; López-Pina, José Antonio

2009-08-01

The purpose of this study was to analyze the component structure and reliability of the Liebowitz Social Anxiety Scale for Children and Adolescents, self-report version (LSAS-CA-SR), in a Spanish community population. The sample was made up of 422 students from elementary and high schools, aged between 10 and 17 years. Exploratory factor analysis isolated one component for the Anxiety subscale and one component for the Avoidance subscale. Medium-strong associations were found between the total score and subscale scores. LSAS-CA-SR scores had stronger associations with instruments of social anxiety. Internal consistency for the Fear subscale was .91, and for the Avoidance subscale, it was .89. Gender and age effects were assessed for LSAS-CA-SR scores. Effect sizes for age and gender and interaction of age and gender were very low on both the Fear and the Avoidance subscales. There were significant differences between female and male means on the Fear subscale. The findings suggest that the LSAS-CA-SR is reliable and valid.

A Cross-cultural Study of the Back Pain Beliefs of Female Undergraduate Healthcare Students.

PubMed

Burnett, Angus; Sze, Ching Ching; Tam, Suet May; Yeung, Ka Man; Leong, Michelle; Wang, Wendy Tj; Tan, B-K; O'sullivan, Peter

2009-01-01

To determine if country (Australia, Taiwan, Singapore), undergraduate healthcare course (physiotherapy, nursing), low back pain (LBP) history, and year of course influenced various back pain beliefs in undergraduate female healthcare students. Three hundred and 82 female undergraduate nursing and physiotherapy students completed questionnaires examining; the inevitability of future life with low back trouble, the LBP beliefs held by healthcare providers and fear avoidance beliefs related to physical activity. Also participants completed questionnaires to determine their LBP status. General linear models were used to determine whether differences existed for back beliefs scores. Differences were evident in the future consequence of LBP between countries (P<0.001), undergraduate course (P<0.001), and LBP status (P=0.021). Healthcare provider beliefs were found to be significantly influenced by course only (P<0.001). Fear avoidance beliefs related to physical activity were influenced by country (P=0.002) and undergraduate course (P<0.001). When compared with white Australians, Taiwanese and Singaporean Chinese displayed more negative back beliefs regarding the future consequence of LBP (P<0.001) and more fear avoidant beliefs toward physical activity (P=0.021 and P<0.001, respectively). Further, nursing students had more negative back pain beliefs than physiotherapy students (P<0.001) and, the experience of LBP was associated with more positive beliefs on the future consequence of back trouble (P=0.021). Findings of this study highlight the importance of country, education, and LBP experience on back pain beliefs. The more negative back pain beliefs found in Taiwan and Singapore may reflect current pain beliefs and management attitudes.

Fear of Success, Sex-Role Orientation of the Task, and Competitive Condition as Variables Affecting Women's Performance in Achievement-Oriented Situations.

ERIC Educational Resources Information Center

Makosky, Vivian P.

It has been suggested that for women, success in competitive achievement situations may produce negative social sanctions, resulting in a motive to avoid success, which inhibits high performance in these situations. 120 college women, 60 exhibiting fear of success and 60 exhibiting no fear of success, based upon results of a projective measure,…

Prior fear conditioning does not impede enhanced active avoidance in serotonin transporter knockout rats.

PubMed

Schipper, Pieter; Henckens, Marloes J A G; Borghans, Bart; Hiemstra, Marlies; Kozicz, Tamas; Homberg, Judith R

2017-05-30

Stressors can be actively or passively coped with, and adequate adaption of the coping response to environmental conditions can reduce their potential deleterious effects. One major factor influencing stress coping behaviour is serotonin transporter (5-HTT) availability. Abolishment of 5-HTT is known to impair fear extinction but facilitates acquisition of signalled active avoidance (AA), a behavioural task in which an animal learns to avoid an aversive stimulus that is predicted by a cue. Flexibility in adapting coping behaviour to the nature of the stressor shapes resilience to stress-related disorders. Therefore, we investigated the relation between 5-HTT expression and ability to adapt a learned coping response to changing environmental conditions. To this end, we first established and consolidated a cue-conditioned passive fear response in 5-HTT -/- and wildtype rats. Next, we used the conditioned stimulus (CS) to signal oncoming shocks during signalled AA training in 5-HTT -/- and wildtype rats to study their capability to acquire an active coping response to the CS following fear conditioning. Finally, we investigated the behavioural response to the CS in a novel environment and measured freezing, exploration and self-grooming, behaviours reflective of stress coping strategy. We found that fear conditioned and sham conditioned 5-HTT -/- animals acquired the signalled AA response faster than wildtypes, while prior conditioning briefly delayed AA learning similarly in both genotypes. Subsequent exposure to the CS in the novel context reduced freezing and increased locomotion in 5-HTT -/- compared to wildtype rats. This indicates that improved AA performance in 5-HTT -/- rats resulted in a weaker residual passive fear response to the CS in a novel context. Fear conditioning prior to AA training did not affect freezing upon re-encountering the CS, although it did reduce locomotion in 5-HTT -/- rats. We conclude that independent of 5-HTT signalling, prior fear conditioning does not greatly impair the acquisition of subsequent active coping behaviour when the situation allows for it. Abolishment of 5-HTT results in a more active coping style in case of novelty-induced fear and upon CS encounter in a novel context after AA learning. Copyright © 2017 Elsevier B.V. All rights reserved.

Understanding catastrophizing from a misdirected problem-solving perspective.

PubMed

Flink, Ida K; Boersma, Katja; MacDonald, Shane; Linton, Steven J

2012-05-01

The aim is to explore pain catastrophizing from a problem-solving perspective. The links between catastrophizing, problem framing, and problem-solving behaviour are examined through two possible models of mediation as inferred by two contemporary and complementary theoretical models, the misdirected problem solving model (Eccleston & Crombez, 2007) and the fear-anxiety-avoidance model (Asmundson, Norton, & Vlaeyen, 2004). In this prospective study, a general population sample (n= 173) with perceived problems with spinal pain filled out questionnaires twice; catastrophizing and problem framing were assessed on the first occasion and health care seeking (as a proxy for medically oriented problem solving) was assessed 7 months later. Two different approaches were used to explore whether the data supported any of the proposed models of mediation. First, multiple regressions were used according to traditional recommendations for mediation analyses. Second, a bootstrapping method (n= 1000 bootstrap resamples) was used to explore the significance of the indirect effects in both possible models of mediation. The results verified the concepts included in the misdirected problem solving model. However, the direction of the relations was more in line with the fear-anxiety-avoidance model. More specifically, the mediation analyses provided support for viewing catastrophizing as a mediator of the relation between biomedical problem framing and medically oriented problem-solving behaviour. These findings provide support for viewing catastrophizing from a problem-solving perspective and imply a need to examine and address problem framing and catastrophizing in back pain patients. ©2011 The British Psychological Society.

De-educate to re-educate: aging and low back pain.

PubMed

Louw, Adriaan; Zimney, Kory; Johnson, Eldon A; Kraemer, Chris; Fesler, Justin; Burcham, Tyler

2017-12-01

Patients' beliefs about their condition have been shown to play a significant role in their pain experience and response to treatment, especially when a patient sees their tissue health as vulnerable or aged. Educational can alter these beliefs. Prior to new information, patients often have to be de-educated regarding common misbeliefs to undergo re-education. To determine if a brief de-education session regarding aging and low back pain (LBP) can shift pain ratings, fear-avoidance beliefs, beliefs regarding aging and LBP, and limited active trunk flexion. Fifty adults ranging from 50 to 93 years of age (SD = 10.73) with a 15.1 years of LBP were education on the poor correlation between aging and LBP. Prior to and immediately after the education pain ratings for LBP and leg pain (numeric pain rating scale-NPRS), fear-avoidance (fear avoidance beliefs questionnaire-FABQ), beliefs regarding aging and LBP (Likert scale) and active trunk flexion were measured. Significant changes were found in positive shifts with LBP (p = 0.002), leg pain (p = 0.042), FABQ-physical activity subscale (p = 0.004) and active trunk forward flexion (p < 0.001). The results show that education aimed at altering beliefs regarding LBP and aging result in a positive shift in pain, fear avoidance related to physical activity and active trunk flexion. Prior to providing patients with new healthcare information, de-educating them regarding poor beliefs may be helpful in shifting them towards new, healthier paradigms associated with their condition.

From normal fear to pathological anxiety.

PubMed

Rosen, J B; Schulkin, J

1998-04-01

In this article the authors address how pathological anxiety may develop from adaptive fear states. Fear responses (e.g., freezing, startle, heart rate and blood pressure changes, and increased vigilance) are functionally adaptive behavioral and perceptual responses elicited during danger to facilitate appropriate defensive responses that can reduce danger or injury (e.g., escape and avoidance). Fear is a central motive state of action tendencies subserved by fear circuits, with the amygdala playing a central role. Pathological anxiety is conceptualized as an exaggerated fear state in which hyperexcitability of fear circuits that include the amygdala and extended amygdala (i.e., bed nucleus of the stria terminalis) is expressed as hypervigilance and increased behavioral responsivity to fearful stimuli. Reduced thresholds for activation and hyperexcitability in fear circuits develop through sensitization- or kindling-like processes that involve neuropeptides, hormones, and other proteins. Hyperexcitability in fear circuits is expressed as pathological anxiety that is manifested in the various anxiety disorders.

[Relationship between early maladaptive schemas, attachment quality and fear of darkness].

PubMed

Kopcsó, Krisztina; Láng, András

2014-12-07

Although fear of darkness is most common in childhood, it is also a remarkable phenomenon in young adulthood. To examine the relationship between fear of darkness, early maladaptive schemas and attachment quality in young adults and assess fear related sex differences. A self-developed scale was used to measure fear of darkness' intensity and frequency. Young Schema Questionnaire - Short Form and two scales that measure attachment dimensions were also applied. 120 university students (68 women, 52 men) filled in the tests. Fear of darkness' frequency correlated with avoidant attachment, and intensity with independent and anxious attachment. Fear of darkness variables correlated with several early maladaptive schemas. Women reported more frequent and intensive fear of darkness than men. These results indicated that the elevated level of fear of darkness is related to specific cognitive style and attachment quality. This highlights the potential clinical relevance of fear of darkness.

Estradiol levels in women predict skin conductance response but not valence and expectancy ratings in conditioned fear extinction.

PubMed

White, Emily C; Graham, Bronwyn M

2016-10-01

Anxiety disorders are more prevalent in women than men. One contributing factor may be the sex hormone estradiol, which is known to impact the long term recall of conditioned fear extinction, a laboratory procedure that forms the basis of exposure therapy for anxiety disorders. To date, the literature examining estradiol and fear extinction in humans has focused primarily on physiological measures of fear, such as skin conductance response (SCR) and fear potentiated startle. This is surprising, given that models of anxiety identify at least three important components: physiological symptoms, cognitive beliefs, and avoidance behavior. To help address this gap, we exposed women with naturally high (n=20) or low estradiol (n=19), women using hormonal contraceptives (n=16), and a male control group (n=18) to a fear extinction task, and measured SCR, US expectancy and CS valence ratings. During extinction recall, low estradiol was associated with greater recovery of SCR, but was not related to US expectancy or CS evaluation. Importantly, women using hormonal contraceptives showed a dissociation between SCR and cognitive beliefs: they exhibited a greater recovery of SCR during extinction recall, yet reported similar US expectancy and CS valence ratings to the other female groups. This divergence underscores the importance of assessing multiple measures of fear when examining the role of estradiol in human fear extinction, especially when considering the potential of estradiol as an enhancement for psychological treatments for anxiety disorders. Copyright © 2016 Elsevier Inc. All rights reserved.

Exciting fear in adolescence: does pubertal development alter threat processing?

PubMed

Spielberg, Jeffrey M; Olino, Thomas M; Forbes, Erika E; Dahl, Ronald E

2014-04-01

Adolescent development encompasses an ostensible paradox in threat processing. Risk taking increases dramatically after the onset of puberty, contributing to a 200% increase in mortality. Yet, pubertal maturation is associated with increased reactivity in threat-avoidance systems. In the first part of this paper we propose a heuristic model of adolescent affective development that may help to reconcile aspects of this paradox, which focuses on hypothesized pubertal increases in the capacity to experience (some) fear-evoking experiences as an exciting thrill. In the second part of this paper, we test key features of this model by examining brain activation to threat cues in a longitudinal study that disentangled pubertal and age effects. Pubertal increases in testosterone predicted increased activation to threat cues, not only in regions associated with threat avoidance (i.e., amygdala), but also regions associated with reward pursuit (i.e., nucleus accumbens). These findings are consistent with our hypothesis that puberty is associated with a maturational shift toward more complex processing of threat cues--which may contribute to adolescent tendencies to explore and enjoy some types of risky experiences. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Social anxiety disorder: questions and answers for the DSM-V.

PubMed

Bögels, Susan M; Alden, Lynn; Beidel, Deborah C; Clark, Lee Anna; Pine, Daniel S; Stein, Murray B; Voncken, Marisol

2010-02-01

This review evaluates the DSM-IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM-IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues. A literature review was conducted, using the validators provided by the DSM-V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM-V. Little supporting evidence was found for the current specifier, generalized SAD. Rather, the symptoms of individuals with SAD appear to fall along a continuum of severity based on the number of fears. Available evidence suggested the utility of a specifier indicating a "predominantly performance" variety of SAD. A specifier based on "fear of showing anxiety symptoms" (e.g., blushing) was considered. However, a tendency to show anxiety symptoms is a core fear in SAD, similar to acting or appearing in a certain way. More research is needed before considering subtyping SAD based on core fears. SAD was found to be a valid diagnosis in children and adolescents. Selective mutism could be considered in part as a young child's avoidance response to social fears. Pervasive test anxiety may belong not only to SAD, but also to generalized anxiety disorder. The data are equivocal regarding whether to consider avoidant personality disorder simply a severe form of SAD. Secondary data analyses, field trials, and validity tests are needed to investigate the recommendations and options.

Treatment hurts: Lay theories of graded exposure in the treatment of four anxiety disorders

PubMed Central

Furnham, Adrian; Wilson, Emma; Chapman, Amy; Persuad, Raj

2013-01-01

Objective This paper concerned the perceived suffering/side effects caused by various well-known treatments for personal problems. It looked at whether people understood whether potentially painful treatments that confront negative aversive affect were effective or not. Method In total, 106 participants completed a long questionnaire assessing the ‘psychological pain’ ratings of 30 psychotherapy treatments, varying in fear exposure, for four relatively common anxiety disorders: social phobia, agoraphobia, post-traumatic stress disorder, and obsessive compulsive disorder. Results Factor analytic results revealed four clear factors underlying lay efficacy beliefs of psychotherapy interventions, varying in fear exposure: talking therapies, fear confrontation, fear avoidance, and alternative therapies. Talking therapies were rated the most effective across all disorders, but also the most painful. Fear avoidance therapies were rated the least effective and, along with alternative medicine, the least painful. Treatments involving fear exposure were rated the most painful. Regression analysis revealed talking therapies to be rated more efficacious by younger subjects than older subjects. Conclusion Most people seem able to differentiate between the efficacies of interventions for different anxiety disorders and hold consensually held optimistic conceptions about the usefulness of psychotherapy treatments and counseling that involve fear exposure, despite knowledge of the psychophysical side effects that these therapies often entail. They favored talking cures over others, but that may have been due to misleading items in the questionnaire. PMID:26405431

Habenula and interpeduncular nucleus differentially modulate predator odor-induced innate fear behavior in rats.

PubMed

Vincenz, Daniel; Wernecke, Kerstin E A; Fendt, Markus; Goldschmidt, Jürgen

2017-08-14

Fear is an important behavioral system helping humans and animals to survive potentially dangerous situations. Fear can be innate or learned. Whereas the neural circuits underlying learned fear are already well investigated, the knowledge about the circuits mediating innate fear is still limited. We here used a novel, unbiased approach to image in vivo the spatial patterns of neural activity in odor-induced innate fear behavior in rats. We intravenously injected awake unrestrained rats with a 99m-technetium labeled blood flow tracer (99mTc-HMPAO) during ongoing exposure to fox urine or water as control, and mapped the brain distribution of the trapped tracer using single-photon emission computed tomography (SPECT). Upon fox urine exposure blood flow increased in a number of brain regions previously associated with odor-induced innate fear such as the amygdala, ventromedial hypothalamus and dorsolateral periaqueductal grey, but, unexpectedly, decreased at higher significance levels in the interpeduncular nucleus (IPN). Significant flow changes were found in regions monosynaptically connected to the IPN. Flow decreased in the dorsal tegmentum and entorhinal cortex. Flow increased in the habenula (Hb) and correlated with odor effects on behavioral defensive strategy. Hb lesions reduced avoidance of but increased approach to the fox urine while IPN lesions only reduced avoidance behavior without approach behavior. Our study identifies a new component, the IPN, of the neural circuit mediating odor-induced innate fear behavior in mammals and suggests that the evolutionarily conserved Hb-IPN system, which has recently been implicated in cued fear, also forms an integral part of the innate fear circuitry. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Forebrain-specific CRF overproduction during development is sufficient to induce enduring anxiety and startle abnormalities in adult mice.

PubMed

Toth, Mate; Gresack, Jodi E; Bangasser, Debra A; Plona, Zach; Valentino, Rita J; Flandreau, Elizabeth I; Mansuy, Isabelle M; Merlo-Pich, Emilio; Geyer, Mark A; Risbrough, Victoria B

2014-05-01

Corticotropin releasing factor (CRF) regulates physiological and behavioral responses to stress. Trauma in early life or adulthood is associated with increased CRF in the cerebrospinal fluid and heightened anxiety. Genetic variance in CRF receptors is linked to altered risk for stress disorders. Thus, both heritable differences and environmentally induced changes in CRF neurotransmission across the lifespan may modulate anxiety traits. To test the hypothesis that CRF hypersignaling is sufficient to modify anxiety-related phenotypes (avoidance, startle, and conditioned fear), we induced transient forebrain-specific overexpression of CRF (CRFOE) in mice (1) during development to model early-life stress, (2) in adulthood to model adult-onset stress, or (3) across the entire postnatal lifespan to model heritable increases in CRF signaling. The consequences of these manipulations on CRF peptide levels and behavioral responses were examined in adulthood. We found that transient CRFOE during development decreased startle habituation and prepulse inhibition, and increased avoidance (particularly in females) recapitulating the behavioral effects of lifetime CRFOE despite lower CRF peptide levels at testing. In contrast, CRFOE limited to adulthood reduced contextual fear learning in females and increased startle reactivity in males but did not change avoidance or startle plasticity. These findings suggest that forebrain CRFOE limited to development is sufficient to induce enduring alterations in startle plasticity and anxiety, while forebrain CRFOE during adulthood results in a different phenotype profile. These findings suggest that startle circuits are particularly sensitive to forebrain CRFOE, and that the impact of CRFOE may be dependent on the time of exposure.

Trait Anxiety and Perceptual Load as Determinants of Emotion Processing in a Fear Conditioning Paradigm

PubMed Central

Fox, Elaine; Yates, Alan; Ashwin, Chris

2012-01-01

The impact of trait anxiety and perceptual load on selective attention was examined in a fear conditioning paradigm. A fear-conditioned angry face (CS+), an unconditioned angry face (CS−), or an unconditioned face with a neutral or happy expression were used in distractor interference and attentional probe tasks. In Experiments 1 and 2, participants classified centrally presented letters under two conditions of perceptual load. When perceptual load was high, distractors had no effect on selective attention, even with aversive conditioning. However, when perceptual load was low, strong response interference effects for CS+ face distractors were found for low trait-anxious participants. Across both experiments, this enhanced distractor interference reversed to strong facilitation effects for those reporting high trait anxiety. Thus, high trait-anxious participants were faster, rather than slower, when ignoring CS+ distractors. Using an attentional probe task in Experiment 3, it was found that fear conditioning resulted in strong attentional avoidance in a high trait-anxious group, which contrasted with enhanced vigilance in a low trait-anxious group. These results demonstrate that the impact of fear conditioning on attention is modulated by individual variation in trait anxiety when perceptual load is low. Fear conditioning elicits an avoidance of threat-relevant stimuli in high trait-anxious participants. PMID:21875186

Using the Subtle Avoidance Frequency Examination in Adolescent Social Anxiety Assessments

ERIC Educational Resources Information Center

Thomas, Sarah A.; Daruwala, Samantha E.; Goepel, Katherine A.; De Los Reyes, Andres

2012-01-01

Background: Individuals with social anxiety use safety behaviors to directly or indirectly avoid social situations (e.g., remaining quiet in a social setting to avoid saying anything embarrassing). Safety behaviors have been hypothesized to prevent the disconfirmation of feared occurrences while in social situations. Further, research indicates…

Avoidance in hypochondriasis.

PubMed

Doherty-Torstrick, Emily R; Walton, Kate E; Barsky, Arthur J; Fallon, Brian A

2016-10-01

The DSM-5 diagnosis of illness anxiety disorder adds avoidance as a component of a behavioral response to illness fears - one that was not present in prior DSM criteria of hypochondriasis. However, maladaptive avoidance as a necessary or useful criterion has yet to be empirically supported. 195 individuals meeting DSM-IV criteria for hypochondriasis based on structured interview completed a variety of self-report and clinician-administered assessments. Data on maladaptive avoidance were obtained using the six-item subscale of the clinician-administered Hypochondriasis - Yale Brown Obsessive Compulsive Scale - Modified. To determine if avoidance emerged as a useful indicator in hypochondriasis, we compared the relative fit of continuous latent trait, categorical latent class, and hybrid factor mixture models. A two-class factor mixture model fit the data best, with Class 1 (n=147) exhibiting a greater level of severity of avoidance than Class 2 (n=48). The more severely avoidant group was found to have higher levels of hypochondriacal symptom severity, functional impairment, and anxiety, as well as lower quality of life. These results suggest that avoidance may be a valid behavioral construct and a useful component of the new diagnostic criteria of illness anxiety in the DSM-5, with implications for somatic symptom disorder. Copyright © 2016 Elsevier Inc. All rights reserved.

Escitalopram reversed the traumatic stress-induced depressed and anxiety-like symptoms but not the deficits of fear memory.

PubMed

Lin, Chen-Cheng; Tung, Che-Se; Liu, Yia-Ping

2016-04-01

Posttraumatic stress disorder (PTSD) is a trauma-induced mental disorder characterised by fear extinction dysfunction in which fear circuit monoamines are possibly associated. PTSD often coexists with depressive/anxiety symptoms, and selective serotonin reuptake inhibitors (SSRIs) are recommended to treat PTSD. However, therapeutic mechanisms of SSRIs underlying the PTSD fear symptoms remain unclear. Using a rodent PTSD model, we examined the effects of early SSRI intervention in mood and fear dysfunctions with associated changes of monoamines within the fear circuit areas. A 14-day escitalopram (ESC) regimen (5 mg/kg/day) was undertaken in two separate experiments in rats which previously received a protocol of single prolonged stress (SPS). In experiment 1, sucrose preference and elevated T-maze were used to index anhedonia depression and avoidance/escape anxiety profiles. In experiment 2, the percentage of freezing time was measured in a 3-day fear conditioning paradigm. At the end of our study, tissue levels of serotonin (5-HT) in the medial prefrontal cortex, amygdala, hippocampus, and striatum were measured in experiment 1, and the efflux levels of infralimbic (IL) monoamines were measured in experiment 2. In experiment 1, ESC corrected both behavioural (depression/anxiety) and neurochemical (reduced 5-HT tissue levels in amygdala/hippocampus) abnormalities. In experiment 2, ESC was unable to correct the SPS-impaired retrieval of fear extinction. In IL, ESC increased the efflux level of 5-HT but failed to reverse SPS-reduced dopamine (DA) and noradrenaline (NA). PTSD-induced mood dysfunction is psychopathologically different from PTSD-induced fear disruption in terms of disequilibrium of monoamines within the fear circuit areas.

Imagery rescripting versus in vivo exposure in the treatment of snake fear.

PubMed

Hunt, Melissa; Fenton, Miriam

2007-12-01

This study compared imagery rescripting, in vivo exposure therapy and their combination in the treatment of snake fear. Imaginal ability was assessed pre-treatment, and was correlated with baseline avoidance. Snake fearful individuals were randomly assigned to cognitive therapy involving imagery rescripting, in vivo exposure, a combination of the two, or a relaxation control. All active treatment groups improved significantly more than the control group in both fearfulness and behavioral approach. There were no significant differences between the active treatment groups, although the combined treatment tended to be slightly more efficacious.

Zebrafish antipredatory responses: A future for translational research?

PubMed Central

Gerlai, Robert

2011-01-01

Human neuropsychiatric conditions associated with abnormally exaggerated or misdirected fear (anxiety disorders and phobias) still represent a large unmet medical need because the biological mechanisms underlying these diseases are not well understood. Animal models have been proposed to facilitate this research. Here I review the literature with a focus on zebrafish, an upcoming laboratory organism in behavioral brain research. I argue that abnormal human fear responses are likely the result of the malfunction of neurobiological mechanisms (brain areas, circuits and/or molecular mechanisms) that originally evolved to support avoidance of predators or other harm in nature. I also argue that the understanding of the normal as well as pathological functioning of such mechanisms may be best achieved if one utilizes naturalistic experimental approaches. In case of laboratory model organisms, this may entail presenting stimuli associated with predators and measuring species-specific antipredatory responses. Although zebrafish is a relatively new subject of such inquiry, I review the recently rapidly increasing number of zebrafish studies in this area, and conclude that zebrafish is a promising research tool for the analysis of the neurobiology and genetics of vertebrate fear responses. PMID:19836422

From Threat to Fear: The neural organization of defensive fear systems in humans

PubMed Central

Mobbs, Dean; Marchant, Jennifer L; Hassabis, Demis; Seymour, Ben; Tan, Geoffrey; Gray, Marcus; Petrovic, Predrag; Dolan, Raymond J.; Frith, Christopher D.

2009-01-01

Post-encounter and circa-strike defensive contexts represent two adaptive responses to potential and imminent danger. In the context of a predator, the post-encounter reflects the initial detection of the potential threat, whilst the circa-strike is associated with direct predatory attack. We used fMRI to investigate the neural organization of anticipation and avoidance of artificial predators with high or low probability of capturing the subject across analogous post-encounter and circa-strike contexts of threat. Consistent with defense systems models, post-encounter threat elicited activity in forebrain areas including subgenual anterior cingulate cortex (sgACC), hippocampus and amygdala. Conversely, active avoidance during circa-strike threat increased activity in mid-dorsal ACC and midbrain areas. During the circa-strike condition, subjects showed increased coupling between the midbrain and mid-dorsal ACC and decreased coupling with the sgACC, amygdala and hippocampus. Greater activity was observed in the right pregenual ACC for high compared to low probability of capture during circa-strike threat. This region showed decreased coupling with the amygdala, insula and ventromedial prefrontal cortex. Finally, we found that locomotor errors correlated with subjective reports of panic for the high compared to low probability of capture during the circa-strike threat and these panic-related locomotor errors were correlated with midbrain activity. These findings support models suggesting that higher forebrain areas are involved in early threat responses, including the assignment and control of fear, whereas as imminent danger results in fast, likely “hard-wired”, defensive reactions mediated by the midbrain. PMID:19793982

Social fear and social phobia types among community youth: differential clinical features and vulnerability factors.

PubMed

Knappe, Susanne; Beesdo-Baum, Katja; Fehm, Lydia; Stein, Murray B; Lieb, Roselind; Wittchen, Hans-Ulrich

2011-01-01

To compare different social fears and social phobia subtypes with regard to clinical (age of onset, avoidance, impairment, comorbidities) and vulnerability factors (behavioural inhibition (BI), parental psychopathology and parental rearing) among community youth. Fears of 6 social situations and Social Phobia (SP), along with their clinical features, were assessed using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI) in a population-based sample of N = 3021 14-24 year olds that were followed up for 10 years. BI and parental rearing were assessed using self-report questionnaires. Parental psychopathology was assessed directly in parents via DIA-X/M-CIDI, supplemented by offsprings' family history reports. In the total sample, 20.0%, 11.6%, 11.7% reported fear of 1, 2, 3 or more social situations, respectively; rates were 24.2%, 18.7%, and 57.1% in SP-cases (6.6% of the total sample). Exploring the factorial structure indicated rather unidimensionality of social fears than mutual distinction of social fears by interaction vs. performance situations. Except for fear of taking tests and public speaking, social fears rarely occurred in isolation. Social fears of both interaction and performance situations were associated with severe avoidance (vs. fear of either situation; Odds Ratios, OR = 1.5, 95%CI: 1.1-1.9) and impairment (OR = 3.6, 95%CI: 2.6-4.9), and more comorbid anxiety and depressive disorders (OR range 3.2-5.8, p > .001). Fear of interaction situations was associated with higher BI (vs. performance-related fears, OR range 1.2-2.1, p < .05). Associations with parental psychopathology and unfavourable parental rearing were less consistent, albeit stronger for fear of interaction situations (vs. performance-related fears). Interactions with time indicated an earlier onset of SP for higher BI, but not for parental psychopathology or unfavourable parental rearing. Interaction-related social fears differ in their clinical and vulnerability factors from performance-related social fears. The current DSM-IV specifier of "generalized" SP may fall short of adequately denoting these differences. Fear of taking tests appears to be conceptually and, possibly, etiologically distinct from other social fears, and may be better placed in another category (e.g., as a type of specific phobia). Copyright © 2010 Elsevier Ltd. All rights reserved.

Coping with fear through suppression and avoidance of threatening information.

PubMed

Nielsen, Jesper; Shapiro, Stewart

2009-09-01

Fear appeal communications are widely used by social marketers in their efforts to persuade individuals to refrain from engaging in risky behaviors. The present research shows that exposure to a fear appeal can lead to the suppression of concepts semantically related to the threat and bias attentional resources away from threat-relevant information. Participants in the experimental condition viewed a fear appeal advertisement depicting the negative consequences of drinking and driving. The results of a reaction time task showed inhibited responses to words semantically related to drinking (e.g., beer, party) relative to a baseline group that controlled for priming effects (Experiment 1a) and level of fear (Experiment 1b). Furthermore, those in the experimental condition were shown to adopt an attention avoidance processing style, decreasing attention to alcohol-related advertisements appearing in a mock magazine (Experiments 2a and 2b). Because processing of alcohol-related advertising has been linked previously to an increase in drinking and driving, inhibited processing of such advertisements suggests a positive outcome of suppression effects. This contrasts with prior claims suggesting that suppression is counter to prevention-based efforts. 2009 APA, all rights reserved

Component fears of claustrophobia associated with mock magnetic resonance imaging.

PubMed

McGlynn, F Dudley; Smitherman, Todd A; Hammel, Jacinda C; Lazarte, Alejandro A

2007-01-01

A conceptualization of claustrophobia [Rachman, S., & Taylor, S. (1993). Analyses of claustrophobia. Journal of Anxiety Disorders, 7, 281-291] was evaluated in the context of magnetic resonance imaging. One hundred eleven students responded to questionnaires that quantified fear of suffocation, fear of restriction, and sensitivity to anxiety symptoms. Sixty-four of them were then exposed to a mock magnetic resonance imaging assessment; maximum subjective fear during the mock assessment was self-reported, behavioral reactions to the mock assessment were characterized, and heart rates before and during the assessment were recorded. Scores for fear of suffocation, fear of restriction, and anxiety sensitivity were used to predict subjective, behavioral, and cardiac fear. Subjective fear during the mock assessment was predicted by fears of suffocation and public anxiousness. Behavioral fear (escape/avoidance) was predicted by fears of restriction and suffocation, and sensitivity to symptoms related to suffocation. Cardiac fear was predicted by fear of public anxiousness. The criterion variance predicted was impressive, clearly sufficient to legitimize both the research preparation and the conceptualization of claustrophobia that was evaluated.

Gender, gender roles, and anxiety: perceived confirmability of self report, behavioral avoidance, and physiological reactivity.

PubMed

Stoyanova, Milena; Hope, Debra A

2012-01-01

Despite the well-documented gender effect in anxiety, less is known about contributing factors to women's greater risk for anxiety and fears. The present study examined the relationship between gender, gender role orientation (i.e., expressivity/instrumentality) and fear of harmless insects (tarantula), using a multimodal approach of self-report measures, a Behavioral Approach Test (BAT), and physiological reactivity. Participants (144 college students; 67 women, 77 men) completed a questionnaire packet and then were instructed to approach a tarantula. We were unable to replicate Pierce and Kirkpatrick's (1992) findings that men underreport anxiety. Consistent with the literature, women in the study experienced greater anxiety and avoidance compared to men. However, men and women did not differ on physiological reactivity during the first 2 min of the BAT. The concordance across avoidance, anxiety and heart rate reactivity differed by gender, suggesting that men and women have different experiences when faced with a fearful object. Furthermore, instrumentality (masculinity) was negatively related to anticipatory anxiety for women but not for men. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Neurobiology and Psychiatric Perspective of Vaginismus: Linking the Pharmacological and Psycho-Social Interventions.

PubMed

Kadir, Zuri Shahidii; Sidi, Hatta; Kumar, Jaya; Das, Srijit; Midin, Marhani; Baharuddin, Najwa

2018-01-01

Vaginismus is an involuntary muscle contraction of the outer third of vaginal barrel causing sexual penetration almost impossible. It is generally classified under sexual pain disorder (SPD). In Diagnostic and Statistical Manual, 5th edition (DSM-5), it is classified under the new rubric of Genito-Pelvic Pain/Sexual Penetration Disorder. This fear-avoidance condition poses an ongoing significant challenge to the medical and health professionals due to the very demanding needs in health care despite its unpredictable prognosis. The etiology of vaginismus is complex: through multiple biopsycho- social processes, involving bidirectional connections between pelvic-genital (local) and higher mental function (central regulation). It has robust neural and psychological-cognitive loop feedback involvement. The internal neural circuit involves an inter-play of at least two-pathway systems, i.e. both "quick threat assessment" of occipital-limbic-occipital-prefrontal-pelvic-genital; and the chronic pain pathways through the genito-spinothalamic-parietal-pre-frontal system, respectively. In this review, a neurobiology root of vaginismus is deliberated with the central role of an emotional-regulating amygdala, and other neural loop, i.e. hippocampus and neo-cortex in the core psychopathology of fear, disgust, and sexual avoidance. Many therapists view vaginismus as a neglected art-and-science which demands a better and deeper understanding on the clinico-pathological correlation to enhance an effective model for the bio-psycho-social treatment. As vaginismus has a strong presentation in psychopathology, i.e. fear of penetration, phobic avoidance, disgust, and anticipatory anxiety, we highlighted a practical psychiatric approach to the clinical management of vaginismus, based on the current core knowledge in the perspective of neuroscience. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Big Worry: Implications of Anxiety in Indigenous Youth

ERIC Educational Resources Information Center

Adermann, Jenny; Campbell, Marilyn

2007-01-01

Excessive anxiety and worry can prevent young people from participating fully in school and life opportunities. Anxiety can involve fear of being apart from significant people or being left alone; avoidance of certain situations or activities for fear of embarrassment; worrying about normal life issues; repetitive thoughts and behaviours used as…

Latent Growth Curve Analysis of Fear during a Speech Task before and after Treatment for Social Phobia

PubMed Central

Price, Matthew; Anderson, Page L.

2011-01-01

Models of social phobia highlight the importance of anticipatory anxiety in the experience of fear during a social situation. Anticipatory anxiety has been shown to be highly correlated with performance anxiety for a variety of social situations. A few studies show that average ratings of anxiety during the anticipation and performance phases of a social situation decline following treatment. Evidence also suggests that the point of confrontation with the feared stimulus is the peak level of fear. No study to date has evaluated the pattern of anxious responding across the anticipation, confrontation, and performance phases before and after treatment, which is the focus of the current study. Socially phobic individuals (N=51) completed a behavioral avoidance task before and after two types of manualized cognitive behavioral therapy, and gave ratings of fear during the anticipation and performance phases. Results from latent growth curve analysis were the same for the two treatments and suggest that before treatment, anxiety sharply increased during the anticipation phase, was highly elevated at the confrontation, and, to a gradually increased during the performance phase. After treatment, anxiety increased during the anticipation phase, although at a much slower rate than at pretreatment, peaking at confrontation, and declined at the performance phase. The findings suggest that anticipatory experiences are critical to the experience of fear for public speaking and should be incorporated into exposures. PMID:21907972

When pain meets … pain-related choice behavior and pain perception in different goal conflict situations.

PubMed

Schrooten, Martien G S; Wiech, Katja; Vlaeyen, Johan W S

2014-11-01

Individuals in pain often face the choice between avoiding pain and pursuing other equally valued goals. However, little is known about pain-related choice behavior and pain perception in goal conflict situations. Seventy-eight healthy volunteers performed a computerized task requiring repeated choices between incompatible options, differing in their effect on probability to receive painful stimulation and money. Depending on group assignment, participants chose between increased pain probability versus decreased money probability (avoidance-avoidance conflict situation); decreased pain probability versus increased money probability (approach-approach conflict situation); or decrease versus increase in both probabilities (double approach/avoidance conflict situation). During the choice task, participants rated painfulness, unpleasantness, threat, and fearfulness associated with the painful stimulation and how they felt. Longer choice latency and more choice switching were associated with higher retrospective ratings of conflict and of decision difficulty, and more equal importance placed on pain avoidance and earning money. Groups did not differ in choice behavior, pain stimulus ratings, or affect. Across groups, longer choice latencies were nonsignificantly associated with higher pain, unpleasantness, threat, and fearfulness. In the avoidance-avoidance group, more choice switching was associated with higher pain-related threat and fearfulness, and with more negative affect. These results of this study suggest that associations between choice behaviors, pain perception, and affect depend on conflict situation. We present a first experimental demonstration of the relationship between pain-related choice behaviors, pain, and affect in different goal conflict situations. This experimental approach allows us to examine these relationships in a controlled fashion. Better understanding of pain-related goal conflicts and their resolution may lead to more effective pain treatment. Copyright © 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.

Trajectories of change across outcomes in intensive treatment for adolescent panic disorder and agoraphobia.

PubMed

Gallo, Kaitlin P; Cooper-Vince, Christine E; Hardway, Christina L; Pincus, Donna B; Comer, Jonathan S

2014-01-01

Much remains to be learned about typical and individual growth trajectories across treatment for adolescent panic disorder with and without agoraphobia and about critical treatment points associated with key changes. The present study examined the rate and shape of change across an 8-day intensive cognitive behavioral therapy for adolescent panic disorder with and without agoraphobia (N = 56). Participants ranged in age from 12 to 17 (M = 15.14, SD = 1.70; 58.9% female, 78.6% Caucasian). Multilevel modeling evaluated within-treatment linear and nonlinear changes across three treatment outcomes: panic severity, fear, and avoidance. Overall panic severity showed linear change, decreasing throughout treatment. In contrast, fear and avoidance ratings both showed cubic change, peaking slightly at the first session of treatment, starting to decrease at the second session of treatment, and with large gains continuing then plateauing at the fourth session. Findings are considered with regard to the extent to which they may elucidate critical treatment components and sessions for adolescents with panic disorder with and without agoraphobia.

Perceived exertion at work in women with fibromyalgia: explanatory factors and comparison with healthy women.

PubMed

Palstam, Annie; Larsson, Anette; Bjersing, Jan; Löfgren, Monika; Ernberg, Malin; Bileviciute-Ljungar, Indre; Ghafouri, Bijar; Sjörs, Anna; Larsson, Britt; Gerdle, Björn; Kosek, Eva; Mannerkorpi, Kaisa

2014-09-01

To investigate perceived exertion at work in women with fibromyalgia. A controlled cross-sectional multi-centre study. Seventy-three women with fibromyalgia and 73 healthy women matched by occupation and physical workload were compared in terms of perceived exertion at work (0-14), muscle strength, 6-min walk test, symptoms rated by Fibromyalgia Impact Questionnaire (FIQ), work status (25-100%), fear avoidance work beliefs (0-42), physical activity at work (7-21) and physical workload (1-5). Spearman's correlation coefficient and linear regression analysis were conducted. Perceived exertion at work was significantly higher in the fibromyalgia group than in the reference group (p = 0.002), while physical activity at work did not differ between the groups. Physical capacity was lower and symptom severity higher in fibromyalgia compared with references (p < 0.05). In fibromyalgia, perceived exertion at work showed moderate correlation with physical activity at work, physical workload and fear avoidance work beliefs (rs = 0.53-0.65, p < 0.001) and a fair correlation with anxiety (rs = 0.26, p = 0.027). Regression analysis indicated that the physical activity at work and fear avoidance work beliefs explained 50% of the perceived exertion at work. Women with fibromyalgia perceive an elevated exertion at work, which is associated with physical work-related factors and factors related to fear and anxiety.

Emotion-Oriented Coping, Avoidance Coping, and Fear of Pain as Mediators of the Relationship between Positive Affect, Negative Affect, and Pain-Related Distress among African American and Caucasian College Women

ERIC Educational Resources Information Center

Lightsey, Owen Richard, Jr.; Wells, Anita G.; Wang, Mei-Chuan; Pietruszka, Todd; Ciftci, Ayse; Stancil, Brett

2009-01-01

The authors tested whether coping styles and fear of pain mediate the relationship between positive affect and negative affect on one hand and pain-related distress (PD) on the other. Among African American and Caucasian female college students, negative affect, fear of pain, and emotion-oriented coping together accounted for 34% of the variance…

Trait anxiety and perceptual load as determinants of emotion processing in a fear conditioning paradigm.

PubMed

Fox, Elaine; Yates, Alan; Ashwin, Chris

2012-04-01

The impact of trait anxiety and perceptual load on selective attention was examined in a fear conditioning paradigm. A fear-conditioned angry face (CS+), an unconditioned angry face (CS-), or an unconditioned face with a neutral or happy expression were used in distractor interference and attentional probe tasks. In Experiments 1 and 2, participants classified centrally presented letters under two conditions of perceptual load. When perceptual load was high, distractors had no effect on selective attention, even with aversive conditioning. However, when perceptual load was low, strong response interference effects for CS+ face distractors were found for low trait-anxious participants. Across both experiments, this enhanced distractor interference reversed to strong facilitation effects for those reporting high trait anxiety. Thus, high trait-anxious participants were faster, rather than slower, when ignoring CS+ distractors. Using an attentional probe task in Experiment 3, it was found that fear conditioning resulted in strong attentional avoidance in a high trait-anxious group, which contrasted with enhanced vigilance in a low trait-anxious group. These results demonstrate that the impact of fear conditioning on attention is modulated by individual variation in trait anxiety when perceptual load is low. Fear conditioning elicits an avoidance of threat-relevant stimuli in high trait-anxious participants. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment.

PubMed

Thomas, Jennifer J; Lawson, Elizabeth A; Micali, Nadia; Misra, Madhusmita; Deckersbach, Thilo; Eddy, Kamryn T

2017-08-01

DSM-5 defined avoidant/restrictive food intake disorder (ARFID) as a failure to meet nutritional needs leading to low weight, nutritional deficiency, dependence on supplemental feedings, and/or psychosocial impairment. We summarize what is known about ARFID and introduce a three-dimensional model to inform research. Because ARFID prevalence, risk factors, and maintaining mechanisms are not known, prevailing treatment approaches are based on clinical experience rather than data. Furthermore, most ARFID research has focused on children, rather than adolescents or adults. We hypothesize a three-dimensional model wherein neurobiological abnormalities in sensory perception, homeostatic appetite, and negative valence systems underlie the three primary ARFID presentations of sensory sensitivity, lack of interest in eating, and fear of aversive consequences, respectively. Now that ARFID has been defined, studies investigating risk factors, prevalence, and pathophysiology are needed. Our model suggests testable hypotheses about etiology and highlights cognitive-behavioral therapy as one possible treatment.

Fear of clowns in hospitalized children: prospective experience.

PubMed

Meiri, Noam; Schnapp, Zeev; Ankri, Amichi; Nahmias, Itay; Raviv, Amnon; Sagi, Omer; Hamad Saied, Mohamad; Konopnicki, Muriel; Pillar, Giora

2017-02-01

Medical clowns (MC) have become an integral part of the pediatric staff of hospital wards. While several studies have demonstrated the huge benefits of MC, there are almost no data regarding fear of clowns, a known phenomenon that means an irrational fear of clowns. In the current study, we sought to examine the prevalence of fear of clowns in pediatrics wards, and to characterize the affected children. The clinical work of three certified MCs was prospectively assessed. Every child with fear of clowns was noted, data were retrieved from the medical records, and the parents/child completed a specific questionnaire with a research assistant. Fear of clowns was defined as crying, anxiety response or effort to avoid contact with the MCs in small children, while in older children, it was determined if the child either reported fear of MCs or made actions to avoid clowns' intervention. A total of 1160 children participated in the study. All were hospitalized in the department of pediatrics or the pediatric emergency medicine department at Carmel Medical Center, and were exposed to a MC intervention session. Of the 1160 children, 14 children experienced fear of clowns (1.2%). The average age of children who experienced fear of clowns was 3.5 years (range 1-15). Interestingly, most of the children demonstrating fear of clowns were girls (12 out of 14, 85.7%). We found no association between fear of clowns and specific diagnosis, fever, clinical appearance, religion, or ethnicity. The prevalence of fear of clowns in the general pediatric hospitalized population was 1.2%, with a significant predominance of girls (85.7%). Children who experienced significant fear of clowns also experienced significant fear of encountering or thinking about a MC visit. Fear of clowns can affect children at any age (range 1-15), any ethnicity, religion, or degree of illness. Further large scale studies are required to better understand this unique phenomenon of fear of clowns. What is Known: • Fear of clowns is a phenomenon known for more than several decades and related to the increased use of clowns as negative characters in horror movies and TV shows. • The increased use of medical clowns in hospital wards and corridors increases the significance of defining and characterizing this phenomenon in hospital wards. What is New: • The study is novel by giving new data related to the extent of fear of clowns in pediatrics wards and giving demographic characteristic of children experiencing fear of clowns.

The Back Belief Questionnaire is efficient to assess false beliefs and related fear in low back pain populations: A transcultural adaptation and validation study.

PubMed

Dupeyron, Arnaud; Lanhers, Charlotte; Bastide, Sophie; Alonso, Sandrine; Toulotte, Matthias; Jourdan, Claire; Coudeyre, Emmanuel

2017-01-01

According to the fear avoidance model, beliefs and thoughts can modify the outcome of patient with low back pain. The Back Belief Questionnaire (BBQ)-a 14 items scale-assesses these consequences of low back pain. To test the psychometric properties of the French version of the BBQ. The BBQ was translated using the forward-backward translation process. Throughout three repeated evaluation time points (D1, D7 and D30), various aspects of validity were analysed: acceptability, quality of items, unidimentionality, internal consistency, temporal stability (between D1 and D7), responsiveness (between D7 and D30), and construct validity comparing it to other validated scales. One hundred and thirty-one patients were enrolled and 128 were analyzed. The acceptability and the quality of the items were excellent. The scale was unidimensional and reliable (internal consistency: Cronbach's α = 0.8). The responsiveness was moderate but in line with other scores. The BBQ was, as expected, convergent with day-to-day activities and fear avoidance (FABQ and Tampa), disability (Quebec and Dallas scores), or anxiety and depression (HAD); and not correlated with pain. Best correlations were found with Tampa and FABQ. The temporal stability (test-retest reliability) was poor. However, similar changes were observed in near conceptual score (FABQ), which confirmed that clinical status may have not been stable and suggesting sensitivity to early changes for BBQ. The BBQ showed good psychometric properties to assess false beliefs and related fear in French or English LBP populations and can be used either for evaluation in international trials or as a part of self-care training.

Extinction of conditioned opiate withdrawal in rats is blocked by intracerebroventricular infusion of an NMDA receptor antagonist.

PubMed

Coleman, Brian R; Carlezon, William A; Myers, Karyn M

2013-04-29

Maladaptive conditioned responses (CRs) contribute to psychiatric disorders including anxiety disorders and addiction. Methods of reducing these CRs have been considered as possible therapeutic approaches. One such method is extinction, which involves exposure to CR-eliciting cues in the absence of the event they once predicted. In animal models, extinction reduces both fear and addiction-related CRs, and in humans, extinction-based cue exposure therapy (CET) reduces fear CRs. However, CET is less effective in drug addicts, for reasons that are not clear. Increased understanding of the neurobiology of extinction of drug-related CRs as compared to fear CRs may help illuminate this issue. Here, we examine the N-methyl-d-aspartate (NMDA) receptor-dependence of extinction of conditioned opiate withdrawal in rats. Using a place conditioning paradigm, we trained morphine-dependent rats to associate an environment with naloxone-precipitated withdrawal. We then extinguished that association by returning the rats repeatedly to the environment in the absence of acute withdrawal. In some rats we administered the NMDA receptor antagonist d,l-2-amino-5-phosphovaleric acid (AP5) intracerebroventricularly immediately prior to extinction training. In a subsequent test session, these rats avoided the formerly naloxone-paired environment, similar to rats that had not undergone extinction training. By contrast, rats that received vehicle prior to extinction training did not avoid the formerly naloxone-paired environment. This finding indicates that extinction of a drug-related CR (conditioned opiate withdrawal) is dependent on NMDA receptors, similar to extinction of conditioned fear. The locus of the critical NMDA receptors is unclear but may include basolateral amygdala and/or medial prefrontal cortex. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Extinction of conditioned opiate withdrawal in rats is blocked by intracerebroventricular infusion of an NMDA receptor antagonist

PubMed Central

Coleman, Brian R.; Carlezon, William A.; Myers, Karyn M.

2015-01-01

Maladaptive conditioned responses (CRs) contribute to psychiatric disorders including anxiety disorders and addiction. Methods of reducing these CRs have been considered as possible therapeutic approaches. One such method is extinction, which involves exposure to CR-eliciting cues in the absence of the event they once predicted. In animal models, extinction reduces both fear and addiction-related CRs, and in humans, extinction-based cue exposure therapy (CET) reduces fear CRs. However, CET is less effective in drug addicts, for reasons that are not clear. Increased understanding of the neurobiology of extinction of drug-related CRs as compared to fear CRs may help illuminate this issue. Here, we examine the N-methyl-D-aspartate (NMDA) receptor-dependence of extinction of conditioned opiate withdrawal in rats. Using a place conditioning paradigm, we trained morphine-dependent rats to associate an environment with naloxone-precipitated withdrawal. We then extinguished that association by returning the rats repeatedly to the environment in the absence of acute withdrawal. In some rats we administered the NMDA receptor antagonist D,L-2-amino-5-phosphovaleric acid (AP5) intracerebroventricularly immediately prior to extinction training. In a subsequent test session, these rats avoided the formerly naloxone-paired environment, similar to rats that had not undergone extinction training. By contrast, rats that received vehicle prior to extinction training did not avoid the formerly naloxone-paired environment. This finding indicates that extinction of a drug-related CR (conditioned opiate withdrawal) is dependent on NMDA receptors, similar to extinction of conditioned fear. The locus of the critical NMDA receptors is unclear but may include basolateral amygdala and/or medial prefrontal cortex. PMID:23416323

Development of a New Fear of Hypoglycemia Scale: FH-15

ERIC Educational Resources Information Center

Anarte Ortiz, Maria Teresa; Caballero, Francisco Felix; Ruiz de Adana, Maria Soledad; Rondan, Rosa Maria; Carreira, Monica; Dominguez-Lopez, Marta; Machado, Alberto; Gonzalo-Marin, Montserrat; Tapia, Maria Jose; Valdes, Sergio; Gonzalez-Romero, Stella; Soriguer, Federico C.

2011-01-01

Hypoglycemia is the most common adverse event associated with insulin treatment in diabetes. The consequences of hypoglycemia can be quite aversive and potentially life threatening. The physical sequelae provide ample reason for patients to fear hypoglycemia and avoid episodes. For these reasons, our purpose in this study was to develop a new…

Pyrazine analogs are active components of wolf urine that induce avoidance and fear-related behaviors in deer

PubMed Central

Osada, Kazumi; Miyazono, Sadaharu; Kashiwayanagi, Makoto

2014-01-01

Our previous studies indicated that a cocktail of pyrazine analogs, identified in wolf urine, induced avoidance and fear behaviors in mice. The effects of the pyrazine cocktail on Hokkaido deer (Cervus nippon yesoensis) were investigated in field bioassays at a deer park in Hokkaido, Japan. A set of feeding bioassay trials tested the effects of the pyrazine cocktail odor on the behavior of the deer located around a feeding area in August and September 2013. This odor effectively suppressed the approach of the deer to the feeding area. In addition, the pyrazine cocktail odor provoked fear-related behaviors, such as “tail-flag”, “flight” and “jump” actions, of the deer around the feeding area. This study is the first experimental demonstration that the pyrazine analogs in wolf urine have robust and continual fearful aversive effects on ungulates as well as mice. The pyrazine cocktail might be suitable for a chemical repellent that could limit damage to forests and agricultural crops by wild ungulates. PMID:25177281

Anxiety symptoms and children's eye gaze during fear learning.

PubMed

Michalska, Kalina J; Machlin, Laura; Moroney, Elizabeth; Lowet, Daniel S; Hettema, John M; Roberson-Nay, Roxann; Averbeck, Bruno B; Brotman, Melissa A; Nelson, Eric E; Leibenluft, Ellen; Pine, Daniel S

2017-11-01

The eye region of the face is particularly relevant for decoding threat-related signals, such as fear. However, it is unclear if gaze patterns to the eyes can be influenced by fear learning. Previous studies examining gaze patterns in adults find an association between anxiety and eye gaze avoidance, although no studies to date examine how associations between anxiety symptoms and eye-viewing patterns manifest in children. The current study examined the effects of learning and trait anxiety on eye gaze using a face-based fear conditioning task developed for use in children. Participants were 82 youth from a general population sample of twins (aged 9-13 years), exhibiting a range of anxiety symptoms. Participants underwent a fear conditioning paradigm where the conditioned stimuli (CS+) were two neutral faces, one of which was randomly selected to be paired with an aversive scream. Eye tracking, physiological, and subjective data were acquired. Children and parents reported their child's anxiety using the Screen for Child Anxiety Related Emotional Disorders. Conditioning influenced eye gaze patterns in that children looked longer and more frequently to the eye region of the CS+ than CS- face; this effect was present only during fear acquisition, not at baseline or extinction. Furthermore, consistent with past work in adults, anxiety symptoms were associated with eye gaze avoidance. Finally, gaze duration to the eye region mediated the effect of anxious traits on self-reported fear during acquisition. Anxiety symptoms in children relate to face-viewing strategies deployed in the context of a fear learning experiment. This relationship may inform attempts to understand the relationship between pediatric anxiety symptoms and learning. © 2017 Association for Child and Adolescent Mental Health.

Prognostic psychosocial factors for disabling low back pain in Japanese hospital workers.

PubMed

Yoshimoto, Takahiko; Oka, Hiroyuki; Katsuhira, Junji; Fujii, Tomoko; Masuda, Katsuhiko; Tanaka, Sakae; Matsudaira, Ko

2017-01-01

Although the occupational health field has identified psychosocial factors as risk factors for low back pain that causes disability, the association between disabling low back pain and psychosocial factors has not been examined adequately in Japanese hospital workers. Therefore, this study examined the association between low back pain, which interfered with work, and psychosocial factors in Japanese hospital workers. This cross-sectional study was conducted at a hospital in Japan. In total, 280 hospital workers were recruited from various occupational settings. Of these, 203 completed a self-administered questionnaire that included items concerning individual characteristics, severity of low back pain, fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), somatic symptoms (Somatic Symptom Scale-8), psychological distress (K6), workaholism, and work-related psychosocial factors (response rate: 72.5%). Logistic regression was used to explore risk factors associated with disabling low back pain. Of the 203 participants who completed questionnaires, 36 (17.7%) reported low back pain that interfered with their work. Multivariate analyses with individual factors and occupations adjusted for showed statistically significant associations between disabling low back pain and fear-avoidance beliefs (adjusted odds ratio [OR]: 2.619, 95% confidence interval [CI]: 1.003-6.538], somatic symptoms (OR: 4.034, 95% CI: 1.819-9.337), and interpersonal stress at work (OR: 2.619, 95% CI: 1.067-6.224). Psychosocial factors, such as fear-avoidance beliefs, somatic symptoms, and interpersonal relationships at work, were important risk factors in low back pain that interfered with work in Japanese hospital workers. With respect to occupational health, consideration of psychosocial factors is required to reduce disability related to low back pain.

Prognostic psychosocial factors for disabling low back pain in Japanese hospital workers

PubMed Central

Yoshimoto, Takahiko; Oka, Hiroyuki; Katsuhira, Junji; Fujii, Tomoko; Masuda, Katsuhiko; Tanaka, Sakae; Matsudaira, Ko

2017-01-01

Background Although the occupational health field has identified psychosocial factors as risk factors for low back pain that causes disability, the association between disabling low back pain and psychosocial factors has not been examined adequately in Japanese hospital workers. Therefore, this study examined the association between low back pain, which interfered with work, and psychosocial factors in Japanese hospital workers. Method This cross-sectional study was conducted at a hospital in Japan. In total, 280 hospital workers were recruited from various occupational settings. Of these, 203 completed a self-administered questionnaire that included items concerning individual characteristics, severity of low back pain, fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), somatic symptoms (Somatic Symptom Scale-8), psychological distress (K6), workaholism, and work-related psychosocial factors (response rate: 72.5%). Logistic regression was used to explore risk factors associated with disabling low back pain. Results Of the 203 participants who completed questionnaires, 36 (17.7%) reported low back pain that interfered with their work. Multivariate analyses with individual factors and occupations adjusted for showed statistically significant associations between disabling low back pain and fear-avoidance beliefs (adjusted odds ratio [OR]: 2.619, 95% confidence interval [CI]: 1.003–6.538], somatic symptoms (OR: 4.034, 95% CI: 1.819–9.337), and interpersonal stress at work (OR: 2.619, 95% CI: 1.067–6.224). Conclusions Psychosocial factors, such as fear-avoidance beliefs, somatic symptoms, and interpersonal relationships at work, were important risk factors in low back pain that interfered with work in Japanese hospital workers. With respect to occupational health, consideration of psychosocial factors is required to reduce disability related to low back pain. PMID:28531194

Effects of Myofascial Release in Nonspecific Chronic Low Back Pain: A Randomized Clinical Trial.

PubMed

Arguisuelas, María D; Lisón, Juan Francisco; Sánchez-Zuriaga, Daniel; Martínez-Hurtado, Isabel; Doménech-Fernández, Julio

2017-05-01

Double-blind, randomized parallel sham-controlled trial with concealed allocation and intention-to treat analysis. To investigate the effects of an isolate myofascial release (MFR) protocol on pain, disability, and fear-avoidance beliefs in patients with chronic low back pain (CLBP). MFR is a form of manual medicine widely used by physiotherapists in the management of different musculoskeletal pathologies. Up to this moment, no previous studies have reported the effects of an isolated MFR treatment in patients with CLBP. Fifty-four participants, with nonspecific CLBP, were randomized to MFR group (n = 27) receiving four sessions of myofascial treatment, each lasting 40 minutes, and to control group (n = 27) receiving a sham MFR. Variables studied were pain measured by means Short Form McGill Pain Questionnaire (SF-MPQ) and visual analog scale (VAS), disability measured with Roland Morris Questionnaire, and fear-avoidance beliefs measured with Fear-Avoidance Beliefs Questionnaire. Subjects receiving MFR displayed significant improvements in pain (SF-MPQ) (mean difference -7.8; 95% confidence interval [CI]: -14.5 to -1.1, P = 0.023) and sensory SF-MPQ subscale (mean difference -6.1; 95% CI: -10.8 to -1.5, P = 0.011) compared to the sham group, but no differences were found in VAS between groups. Disability and the Fear-Avoidance Beliefs Questionnaire score also displayed a significant decrease in the MFR group (P < 0.05) as compared to sham MFR. MFR therapy produced a significant improvement in both pain and disability. Because the minimal clinically important differences in pain and disability are, however, included in the 95% CI, we cannot know whether this improvement is clinically relevant. 2.

Translation and Validation of the Arabic Version of the Fear-Avoidance Beliefs Questionnaire in Patients With Low Back Pain.

PubMed

Alanazi, Fahad; Gleeson, Peggy; Olson, Sharon; Roddey, Toni

2017-04-01

Prospective cohort study of a cross-cultural low back pain (LBP) questionnaire OBJECTIVE.: The objectives of the present study were to translate and cross-culturally adapt the Fear-Avoidance Beliefs Questionnaire (FABQ) to create a version in Arabic and to test its psychometric properties. The FABQ measures the effects that fear and avoidance beliefs have on work and on physical activity. An FABQ cross-culturally adapted for Arabic readers and speakers was created by forward translation, translation synthesis, and backward translation. Forty patients in Riyadh, Saudi Arabia, with LBP evaluated use of the questionnaire, and 70 patients from the same hospital participated in reliability, validity, and sensitivity studies. To determine test-retest reliability of the Arabic FABQ, patients completed it twice within 48 hours without receiving any active treatment between these two sessions. Patients completed the Arabic FABQ (and three other scales) at baseline and 14 days later to determine its validity and sensitivity. Test-retest reliability was good (FABQ-work: intraclass coefficient [ICC] = 0.74; FABQ-physical activity: ICC = 0.90; FABQ overall: ICC = 0.76). Correlations between the FABQ and three other instruments for measuring pain and disability were weak. The strongest correlation was found at the follow-up session with the Arabic Oswestry Questionnaire (r = 0.283; P ≤ 0.05). Sensitivity to change was low. The translation and adaptation of the Arabic version of the FABQ was successful. Overall, the Arabic FABQ had good test-retest reliability, acceptable construct validity, and low sensitivity to change. The Arabic version of the FABQ shows promise in the assessment of fear-avoidance beliefs among patients with LBP who speak and read Arabic. 3.

The Fear-Avoidance Components Scale (FACS): Responsiveness to Functional Restoration Treatment in a Chronic Musculoskeletal Pain Disorder (CMPD) Population.

PubMed

Neblett, Randy; Mayer, Tom G; Williams, Mark J; Asih, Sali; Cuesta-Vargas, Antonio I; Hartzell, Meredith M; Gatchel, Robert J

2017-12-01

To assess the clinical validity and factor structure of the Fear-Avoidance Components Scale (FACS), a new fear-avoidance measure. In this study, 426 chronic musculoskeletal pain disorder patients were admitted to a Functional Restoration Program (FRP). They were categorized into 5 FACS severity levels, from subclinical to extreme, at admission, and again at discharge. Associations with objective lifting performance and other patient-reported psychosocial measures were determined at admission and discharge, and objective work outcomes for this predominantly disabled cohort, were assessed 1 year later. Those patients in the severe and extreme FACS severity groups at admission were more likely to "drop out" of treatment than those in the lower severity groups (P=0.05). At both admission and discharge, the FACS severity groups were highly and inversely correlated with objective lifting performance and patient-reported fear-avoidance-related psychosocial variables, including kinesiophobia, pain intensity, depressive symptoms, perceived disability, perceived injustice, and insomnia (Ps<0.001). All variables showed improvement at FRP discharge. Patients in the extreme FACS severity group at discharge were less likely to return to, or retain, work 1 year later (P≤0.02). A factor analysis identified a 2-factor solution. Strong associations were found among FACS scores and other patient-reported psychosocial and objective lifting performance variables at both admission and discharge. High discharge-FACS scores were associated with worse work outcomes 1 year after discharge. The FACS seems to be a valid and clinically useful measure for predicting attendance, physical performance, distress, and relevant work outcomes in FRP treatment of chronic musculoskeletal pain disorder patients.

Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain

PubMed Central

Karlsson, Linn; Gerdle, Björn; Takala, Esa-Pekka; Andersson, Gerhard; Larsson, Britt

2016-01-01

Background: Exercise is often used in the treatment of chronic neck and shoulder muscle pain. It is likely that psychological aspects have an impact on the results of exercise-based treatments. Objectives: (1) To examine the associations between psychological factors and the effect of a home-based physical exercise intervention. (2) To examine differences in psychological factors at baseline between (a) subjects who continued in the trial and those who did not and (b) subjects who completed the intervention and those who did not. Method: A total of 57 women with chronic neck and shoulder pain were included in a home-based exercise intervention trial. Pain intensity, disability, and psychological factors (anxiety and depression symptoms, catastrophizing, fear-avoidance beliefs, self-efficacy, and pain acceptance) were measured at baseline, after 4–6 months, and after 1 year of exercise. Associations between the psychological factors and changes in pain intensity and disability were analysed, as well as differences in psychological factors at baseline between subjects who continued in and completed the intervention, and those who did not. Results: Associations between positive changes in pain intensity and disability were found for low fear-avoidance beliefs and low-pain self-efficacy at baseline. In addition, fear-avoidance beliefs at baseline were higher in the subjects who dropped out of the intervention than in those who continued. Pain acceptance at baseline was higher in the subjects who completed the intervention at the end of the trial. Conclusion: Particularly, fear-avoidance beliefs and pain self-efficacy should be taken into consideration when implementing home-based physical exercise as treatment for chronic neck pain. In addition, high pain acceptance might improve the adherence to prescribed exercise. PMID:27688880

Relations among symptoms of social phobia subtypes, avoidant personality disorder, panic, and depression.

PubMed

Carter, Shawn A; Wu, Kevin D

2010-03-01

This study's primary goal was to examine relations between symptoms of specific social phobia (SSP), generalized social phobia (GSP), avoidant personality disorder (APD), and panic and depression. Past research has suggested a single social phobia continuum in which SSP displays less symptom severity than GSP or APD. We found SSP symptoms correlated less strongly with depression but more strongly with panic relative to both GSP and APD symptoms. These findings challenge a unidimensional model of social phobia, suggesting a multidimensional model may be more appropriate. These findings also inform current research aimed at classifying mood and anxiety disorders more broadly by identifying that the different factors of fear versus distress appear to underlie different subtypes of social phobia. 2008. Published by Elsevier Ltd.

Hippocampal awake replay in fear memory retrieval

PubMed Central

Wu, Chun-Ting; Haggerty, Daniel; Kemere, Caleb; Ji, Daoyun

2017-01-01

Hippocampal place cells are key to episodic memories. How these cells participate in memory retrieval remains unclear. Here, after rats acquired a fear memory by receiving mild foot-shocks at a shock zone of a track, we analyzed place cells when the animals were placed back to the track and displayed an apparent memory retrieval behavior: avoidance of the shock zone. We found that place cells representing the shock zone were reactivated, despite the fact that the animals did not enter the shock zone. This reactivation occurred in ripple-associated awake replay of place cell sequences encoding the paths from the animal’s current positions to the shock zone, but not in place cell sequences within individual cycles of theta oscillation. The result reveals a specific place cell pattern underlying the inhibitory avoidance behavior and provides strong evidence for the involvement of awake replay in fear memory retrieval. PMID:28218916

A clinical perspective on a pain neuroscience education approach to manual therapy.

PubMed

Louw, Adriaan; Nijs, Jo; Puentedura, Emilio J

2017-07-01

In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain. PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more. PNE's neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy. Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person's pain experience by increasing fear-avoidance and pain catastrophization. An area of physical therapy where the biomedical model is used a lot is manual therapy. This contrast between PNE and manual therapy has seemingly polarized followers from each approach to see PNE as a 'hands-off' approach even having clinicians categorize patients as either in need of receiving PNE (with no hands-on), or hands-on with no PNE. In this paper, we explore the notion of PNE and manual therapy co-existing. PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization. Using a model of sensitization (innocuous, noxious, and allodynia), we argue that PNE can be used in a manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant. Level of Evidence : VII.

Fear of cancer progression and cancer-related intrusive cognitions in breast cancer survivors.

PubMed

Mehnert, Anja; Berg, Petra; Henrich, Gerhard; Herschbach, Peter

2009-12-01

To assess the character and frequency of fear of progression (FoP) and to clarify its relationship with cancer-related intrusive cognitions in breast cancer survivors. A sample of 1083 patients was recruited in this cross-sectional study through a population-based Cancer Registry an average of 47 month following diagnosis (66% response rate). Participants completed self-report measures assessing fear of cancer progression (FoP-Q-SF), posttraumatic stress-disorder symptoms (PCL-C), coping strategies (DWI) and quality of life (QoL) (SF-8). In total, 23.6% of women were classified as having moderate to high FoP. Being nervous prior to doctors' appointments or examinations and being afraid of relying on strangers for activities of daily living were the most frequent fears. FoP was significantly associated with younger age, having children, disease progress, chemotherapy, perceived amount of impairments, physical and mental QoL, but not with time since initial diagnosis. Intrusive cognitions were screened in 37% of the sample. We found significant correlations between FoP and intrusive thoughts (r=0.63), avoidance (r=0.57), hyperarousal (r=0.54) and posttraumatic stress disorder diagnosis (r=0.42). Factors significantly associated with moderate and high FoP included a depressive coping style as well as an active problem-oriented coping style, intrusion, avoidance and hyperarousal symptoms (Nagelkerke's R(2)=0.44). Findings of this study give information regarding the frequency and the character of anxiety in breast cancer survivors and underline the relation of FoP to the reality of living with breast cancer. Results suggest that intrusive cognitions as well as avoidance and hyperarousal symptoms seem to be closely related to future-oriented fears of cancer recurrence.

An anthropological analysis of the perspectives of Somali women in the West and their obstetric care providers on caesarean birth.

PubMed

Essén, Birgitta; Binder, Pauline; Johnsdotter, Sara

2011-03-01

We explored the perceptions of 39 Somali women and 62 obstetric care providers in London in relation to caesarean birth, as borne out of a paradox we recognised from evidence-based information about the Somali group. Socio-cultural factors potentially leading to adverse obstetric outcome were identified using in-depth and focus group interviews with semi-structured, open-ended questions. A cultural anthropology model, the emic/etic model, was used for analysis. Somali women expressed fear and anxiety throughout the pregnancy and identified strategies to avoid caesarean section (CS). There was widespread, yet anecdotal, awareness among obstetric care providers about negative Somali attitudes. Caesarean avoidance and refusal were expressed as being highly stressful among providers, but also as being the responsibility of the women and families. For women, avoiding or refusing caesarean was based on a rational choice to avoid death and coping with adverse outcome relied on fatalistic attitudes. Motivation for the development of preventive actions among both groups was not described, which lends weight to the vast distinction and lack of correspondence in identified perspectives between Somali women and UK obstetric providers. Early booking and identification of women likely to avoid caesarean is proposed, as is the development of preventive strategies to address CS avoidance.

Dental Fear among Medical and Dental Undergraduates

PubMed Central

Hakim, H.; Razak, I. A.

2014-01-01

Objective. To assess the prevalence and level of dental fear among health related undergraduates and to identify factors causing such fear using Kleinknecht's Dental Fear Survey (DFS) questionnaire. Methods. Kleinknecht's DFS questionnaire was used to assess dental fear and anxiety among the entire enrollment of the medical and dental undergraduates' of the University of Malaya. Results. Overall response rate was 82.2%. Dental students reported higher prevalence of dental fear (96.0% versus 90.4%). However, most of the fear encountered among dental students was in the low fear category as compared to their medical counterpart (69.2 versus 51.2%). Significantly more medical students cancelled dental appointment due to fear compared to dental students (P = 0.004). “Heart beats faster” and “muscle being tensed” were the top two physiological responses experienced by the respondents. “Drill” and “anesthetic needle” were the most fear provoking objects among respondents of both faculties. Conclusion. Dental fear and anxiety are a common problem encountered among medical and dental undergraduates who represent future health care professionals. Also, high level of dental fear and anxiety leads to the avoidance of the dental services. PMID:25386615

[Between the fear of HIV contamination and the symbolic representations of AIDS: the specter of contemporary despair].

PubMed

Meneghin, P

1996-12-01

Lack of knowledge and misinformations on HIV/AIDS are predictors of emotional responses as fear of contagion, homophobia, avoidance and excessive precautions. Fear of contagion is an affective stress response to the neurocognitive activity that leads to a perceived threat of AIDS in connection with the symbolic meanings os illness. Focused interviews were conducted with an opportunistic sample of 31 young people to know the affective responses and behaviors after blood screening for HIV antibody testing. The findings confirm the relationship of symbolic representation of illness as mystery, death, punishment and sexuality to fear of contagion and mitic conception of AIDS.

Fear and disgust in women: Differentiation of cardiovascular regulation patterns.

PubMed

Comtesse, Hannah; Stemmler, Gerhard

2017-02-01

Both fear and disgust facilitate avoidance of threat. From a functional view, however, cardiovascular responses to fear and disgust should differ as they prepare for appropriate behavior to protect from injury and infection, respectively. Therefore, we examined the cardiovascular responses to fear and contamination-related disgust in comparison to an emotionally neutral state induced with auditory scripts and film clips in female participants. Ten emotion and motivation self-reports and ninecardiovascular response factors derived from 23 cardiovascular variables served as dependent variables. Self-reports confirmed the specific induction of fear and disgust. In addition, fear and disgust differed in their cardiovascular response patterning. For fear, we observed specific increases in factors indicating vasoconstriction and cardiac pump function. For disgust, we found specific increases in vagal cardiac control and decreases in myocardial contractility. These findings provide support for the cardiovascular specificity of fear and disgust and are discussed in terms of a basic emotions approach. Copyright © 2016. Published by Elsevier B.V.

Relation of attachment style to family history of alcoholism and alcohol use disorders in early adulthood.

PubMed

Vungkhanching, Martha; Sher, Kenneth J; Jackson, Kristina M; Parra, Gilbert R

2004-07-15

The present study examined the association between paternal alcoholism and attachment style in early adulthood and sought to determine whether attachment style might, at least partially, mediate intergenerational risk for alcoholism. The current report focuses on the cross-sectional relation between family history (FH) of alcoholism, attachment styles, and alcohol use disorders (AUD) when cohort members were, on average, 29 years old (N = 369; 46% male; 51% FH+). Results indicated that FH+ participants were more likely to have insecure attachment, characterized by fearful-avoidant and dismissed-avoidant styles. Additionally, fearful-avoidant and dismissed-avoidant attachment styles were related to the presence of an AUD even after controlling for sex and FH (P < 0.05). There was little evidence, however, that attachment style mediated the relation between paternal alcoholism and AUD in offspring; the FH-AUD association was only negligibly reduced when the effect of attachment style was controlled. Our findings suggest that insecure attachment style is a risk factor for AUD, independent of familial risk for alcoholism.

Do children's previous dental experience and fear affect their perceived oral health-related quality of life (OHRQoL)?

PubMed

Merdad, Leena; El-Housseiny, Azza A

2017-01-16

Oral health-related quality of life (OHRQoL) has been used to describe the consequences of oral health conditions and treatments in children. A better understanding of OHRQoL and its relationship with dental fear and previous dental experience is necessary to improve children's oral health status. The aim of this study was to investigate the association of dental history and experience with dental fear and the OHRQoL of children aged 11 to 14 years. A cross-sectional study was conducted using a multi-stage stratified sample of 1,312 middle school children. Information regarding OHRQoL was collected from the children using the Child Perceptions Questionnaire (CPQ 11-14 ), and information regarding dental fear was collected using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Information on past dental experiences and sociodemographic data were collected from the parents using self-administered questionnaires. Dental examinations were performed to assess caries experience. The multivariable model indicated that dental fear was the strongest predictor of OHRQoL as the fearful children had on average CPQ 11-14 scores that were 10 units higher than those of the non-fearful children. Regarding past dental experience, pain as the reason for the most recent dental visit was associated with poor OHRQoL, while receiving a filling during the previous dental visits was significantly associated with better OHRQoL. In addition, a larger number of siblings, a lower family income, a lower paternal education level, health problems and prior hospitalization were significantly associated with poor OHRQoL. This study identified that dental fear and some factors related to previous dental experience are associated with OHRQoL. In dental practice, children with dental fear should be identified, guided and treated early to avoid deterioration of their OHRQoL.

Sex differences in learning processes of classical and operant conditioning

PubMed Central

Dalla, Christina; Shors, Tracey J.

2009-01-01

Males and females learn and remember differently at different times in their lives. These differences occur in most species, from invertebrates to humans. We review here sex differences as they occur in laboratory rodent species. We focus on classical and operant conditioning paradigms, including classical eyeblink conditioning, fear conditioning, active avoidance and conditioned taste aversion. Sex differences have been reported during acquisition, retention and extinction in most of these paradigms. In general, females perform better than males in the classical eyeblink conditioning, in fear-potentiated startle and in most operant conditioning tasks, such as the active avoidance test. However, in the classical fear conditioning paradigm, in certain lever-pressing paradigms and in the conditioned taste aversion males outperform females or are more resistant to extinction. Most sex differences in conditioning are dependent on organizational effects of gonadal hormones during early development of the brain, in addition to modulation by activational effects during puberty and adulthood. Critically, sex differences in performance account for some of the reported effects on learning and these are discussed throughout the review. Because so many mental disorders are more prevalent on one sex than the other, it is important to consider sex differences in learning when applying animal models of learning for these disorders. Finally, we discuss how sex differences in learning continue to alter the brain throughout the lifespan. Thus, sex differences in learning are not only mediated by sex differences in the brain, but also contribute to them. PMID:19272397

Sex differences in learning processes of classical and operant conditioning.

PubMed

Dalla, Christina; Shors, Tracey J

2009-05-25

Males and females learn and remember differently at different times in their lives. These differences occur in most species, from invertebrates to humans. We review here sex differences as they occur in laboratory rodent species. We focus on classical and operant conditioning paradigms, including classical eyeblink conditioning, fear-conditioning, active avoidance and conditioned taste aversion. Sex differences have been reported during acquisition, retention and extinction in most of these paradigms. In general, females perform better than males in the classical eyeblink conditioning, in fear-potentiated startle and in most operant conditioning tasks, such as the active avoidance test. However, in the classical fear-conditioning paradigm, in certain lever-pressing paradigms and in the conditioned taste aversion, males outperform females or are more resistant to extinction. Most sex differences in conditioning are dependent on organizational effects of gonadal hormones during early development of the brain, in addition to modulation by activational effects during puberty and adulthood. Critically, sex differences in performance account for some of the reported effects on learning and these are discussed throughout the review. Because so many mental disorders are more prevalent in one sex than the other, it is important to consider sex differences in learning when applying animal models of learning for these disorders. Finally, we discuss how sex differences in learning continue to alter the brain throughout the lifespan. Thus, sex differences in learning are not only mediated by sex differences in the brain, but also contribute to them.

Preferential amygdala reactivity to the negative assessment of neutral faces.

PubMed

Blasi, Giuseppe; Hariri, Ahmad R; Alce, Guilna; Taurisano, Paolo; Sambataro, Fabio; Das, Saumitra; Bertolino, Alessandro; Weinberger, Daniel R; Mattay, Venkata S

2009-11-01

Prior studies suggest that the amygdala shapes complex behavioral responses to socially ambiguous cues. We explored human amygdala function during explicit behavioral decision making about discrete emotional facial expressions that can represent socially unambiguous and ambiguous cues. During functional magnetic resonance imaging, 43 healthy adults were required to make complex social decisions (i.e., approach or avoid) about either relatively unambiguous (i.e., angry, fearful, happy) or ambiguous (i.e., neutral) facial expressions. Amygdala activation during this task was compared with that elicited by simple, perceptual decisions (sex discrimination) about the identical facial stimuli. Angry and fearful expressions were more frequently judged as avoidable and happy expressions most often as approachable. Neutral expressions were equally judged as avoidable and approachable. Reaction times to neutral expressions were longer than those to angry, fearful, and happy expressions during social judgment only. Imaging data on stimuli judged to be avoided revealed a significant task by emotion interaction in the amygdala. Here, only neutral facial expressions elicited greater activity during social judgment than during sex discrimination. Furthermore, during social judgment only, neutral faces judged to be avoided were associated with greater amygdala activity relative to neutral faces that were judged as approachable. Moreover, functional coupling between the amygdala and both dorsolateral prefrontal (social judgment > sex discrimination) and cingulate (sex discrimination > social judgment) cortices was differentially modulated by task during processing of neutral faces. Our results suggest that increased amygdala reactivity and differential functional coupling with prefrontal circuitries may shape complex decisions and behavioral responses to socially ambiguous cues.

Preferential Amygdala Reactivity to the Negative Assessment of Neutral Faces

PubMed Central

Blasi, Giuseppe; Hariri, Ahmad R.; Alce, Guilna; Taurisano, Paolo; Sambataro, Fabio; Das, Saumitra; Bertolino, Alessandro; Weinberger, Daniel R.; Mattay, Venkata S.

2010-01-01

Background Prior studies suggest that the amygdala shapes complex behavioral responses to socially ambiguous cues. We explored human amygdala function during explicit behavioral decision making about discrete emotional facial expressions that can represent socially unambiguous and ambiguous cues. Methods During functional magnetic resonance imaging, 43 healthy adults were required to make complex social decisions (i.e., approach or avoid) about either relatively unambiguous (i.e., angry, fearful, happy) or ambiguous (i.e., neutral) facial expressions. Amygdala activation during this task was compared with that elicited by simple, perceptual decisions (sex discrimination) about the identical facial stimuli. Results Angry and fearful expressions were more frequently judged as avoidable and happy expressions most often as approachable. Neutral expressions were equally judged as avoidable and approachable. Reaction times to neutral expressions were longer than those to angry, fearful, and happy expressions during social judgment only. Imaging data on stimuli judged to be avoided revealed a significant task by emotion interaction in the amygdala. Here, only neutral facial expressions elicited greater activity during social judgment than during sex discrimination. Furthermore, during social judgment only, neutral faces judged to be avoided were associated with greater amygdala activity relative to neutral faces that were judged as approachable. Moreover, functional coupling between the amygdala and both dorsolateral prefrontal (social judgment > sex discrimination) and cingulate (sex discrimination > social judgment) cortices was differentially modulated by task during processing of neutral faces. Conclusions Our results suggest that increased amygdala reactivity and differential functional coupling with prefrontal circuitries may shape complex decisions and behavioral responses to socially ambiguous cues. PMID:19709644

Fear of Movement Is Related to Trunk Stiffness in Low Back Pain

PubMed Central

Karayannis, Nicholas V.; Smeets, Rob J. E. M.; van den Hoorn, Wolbert; Hodges, Paul W.

2013-01-01

Background Psychological features have been related to trunk muscle activation patterns in low back pain (LBP). We hypothesised higher pain-related fear would relate to changes in trunk mechanical properties, such as higher trunk stiffness. Objectives To evaluate the relationship between trunk mechanical properties and psychological features in people with recurrent LBP. Methods The relationship between pain-related fear (Tampa Scale for Kinesiophobia, TSK; Photograph Series of Daily Activities, PHODA-SeV; Fear Avoidance Beliefs Questionnaire, FABQ; Pain Catastrophizing Scale, PCS) and trunk mechanical properties (estimated from the response of the trunk to a sudden sagittal plane forwards or backwards perturbation by unpredictable release of a load) was explored in a case-controlled study of 14 LBP participants. Regression analysis (r 2) tested the linear relationships between pain-related fear and trunk mechanical properties (trunk stiffness and damping). Mechanical properties were also compared with t-tests between groups based on stratification according to high/low scores based on median values for each psychological measure. Results Fear of movement (TSK) was positively associated with trunk stiffness (but not damping) in response to a forward perturbation (r2 = 0.33, P = 0.03), but not backward perturbation (r2 = 0.22, P = 0.09). Other pain-related fear constructs (PHODA-SeV, FABQ, PCS) were not associated with trunk stiffness or damping. Trunk stiffness was greater for individuals with high kinesiophobia (TSK) for forward (P = 0.03) perturbations, and greater with forward perturbation for those with high fear avoidance scores (FABQ-W, P = 0.01). Conclusions Fear of movement is positively (but weakly) associated with trunk stiffness. This provides preliminary support an interaction between biological and psychological features of LBP, suggesting this condition may be best understood if these domains are not considered in isolation. PMID:23826339

Specificity of disgust sensitivity in the prediction of fear and disgust responding to a brief spider exposure.

PubMed

Olatunji, Bunmi O; Deacon, Brett

2008-01-01

This study examined the specificity of disgust sensitivity in predicting fear and disgust responses to exposure to a spider. Participants high (n=22) and low (n=28) in spider fear completed self-report measures of disgust sensitivity, contamination fear, anxiety, and negative affect. They then participated in a behavioral avoidance task (BAT) in which they were briefly exposed to a realistic-looking, but fake, tarantula. Results revealed that disgust sensitivity was associated with fear and disgust responding to the BAT. The association between disgust sensitivity and disgust responding to the BAT remained significant after controlling for gender, spider fear group membership, contamination fear, anxiety, and negative affect. However, the association between disgust sensitivity and fear responding to the BAT was only marginally significant after controlling for the same variables. Contamination fear was also strongly related to fear and disgust responding to the BAT. However, this relationship was fully mediated by disgust sensitivity. These findings indicate that disgust sensitivity has a unique association with aversive responding to spiders. The implications of these findings for better understanding the complex role of fear and disgust as they related to disgust sensitivity in spider phobia are discussed.

Fall-related activity avoidance in relation to a history of falls or near falls, fear of falling and disease severity in people with Parkinson's disease.

PubMed

Kader, Manzur; Iwarsson, Susanne; Odin, Per; Nilsson, Maria H

2016-06-02

There is limited knowledge concerning fall-related activity avoidance in people with Parkinson's disease (PD); such knowledge would be of importance for the development of more efficient PD-care and rehabilitation. This study aimed to examine how fall-related activity avoidance relates to a history of self-reported falls/near falls and fear of falling (FOF) as well as to disease severity in people with PD. Data were collected from 251 (61 % men) participants with PD; their median (min-max) age and PD duration were 70 (45-93) and 8 (1-43) years, respectively. A self-administered postal survey preceded a home visit which included observations, clinical tests and interview-administered questionnaires. Fall-related activity avoidance was assessed using the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) as well as by using a dichotomous (Yes/No) question. Further dichotomous questions concerned: the presence of FOF and the history (past 6 months) of falls or near falls, followed by stating the number of incidents. Disease severity was assessed according to the Hoehn and Yahr (HY) stages. In the total sample (n = 251), 41 % of the participants reported fall-related activity avoidance; the median mSAFFE score was 22. In relation to a history of fall, the proportions of participants (p < 0.001) that reported fall-related activity avoidance were: non-fallers (30 %), single fallers (50 %) and recurrent fallers, i.e. ≥ 2 falls (57 %). Among those that reported near falls (but no falls), 51 % (26 out of 51) reported fall-related activity avoidance. Of those that reported FOF, 70 % reported fall-related activity avoidance. Fall-related activity avoidance ranged from 24 % in the early PD-stage (HY I) to 74 % in the most severe stages (HY IV-V). Results indicate that fall-related activity avoidance may be related to a history of self-reported falls/near falls, FOF and disease severity in people with PD. Importantly, fall-related activity avoidance is reported among those that do not fall and already in mild PD-stages (HY I-II). Although further studies are needed, our findings indicate that fall-related activity avoidance needs to be addressed early in order to prevent sedentary behavior and participation restrictions.

Greater avoidance behavior in individuals with posttraumatic stress disorder symptoms

PubMed Central

Sheynin, Jony; Shind, Christine; Radell, Milen; Ebanks-Williams, Yasheca; Gilbertson, Mark W.; Beck, Kevin D.; Myers, Catherine E.

2017-01-01

While avoidance is a core symptom of PTSD, little is known about whether individuals with PTSD show a general cognitive bias to acquire and express avoidance, in situations not related to trauma or fear. Here, we used a computer-based task to examine operant acquisition and extinction of avoidance in participants with and without severe self -reported PTSD symptoms. A total of 119 participants (77 male, 42 female; 74 veteran, 45 civilian) with symptoms (PTSS; n=63) or with few/no symptoms (noPTSS; n=56) performed a task, in which they controlled a spaceship and could shoot a target to gain points or hide in “safe areas” to escape or avoid on-screen aversive events. Results show that participants with PTSS exhibited more avoidance across trials than no PTSS participants, particularly due to more avoidance behavior in PTSS females compared to noPTSS females. Avoidance behavior decreased across extinction trials but interactions with PTSS and gender fell short of significance. Overall, PTSD symptoms were associated with propensity to acquire and express avoidance behavior, in both civilians and veterans, and even in a cognitive task that does not explicitly involve trauma or fear. This effect was more pronounced in females, highlighting the role of gender differences in PTSD symptomatology. Importantly, this study also demonstrates the potential of an objective assessment of avoidance behavior, which could be used to supplement the common but limited self-report tools. PMID:28322068

Greater avoidance behavior in individuals with posttraumatic stress disorder symptoms.

PubMed

Sheynin, Jony; Shind, Christine; Radell, Milen; Ebanks-Williams, Yasheca; Gilbertson, Mark W; Beck, Kevin D; Myers, Catherine E

2017-05-01

While avoidance is a core symptom of PTSD, little is known about whether individuals with PTSD show a general cognitive bias to acquire and express avoidance, in situations not related to trauma or fear. Here, we used a computer-based task to examine operant acquisition and extinction of avoidance in participants with and without severe self-reported PTSD symptoms. A total of 119 participants (77 male, 42 female; 74 veteran, 45 civilian) with symptoms (PTSS; n = 63) or with few/no symptoms (noPTSS; n = 56) performed a task, in which they controlled a spaceship and could shoot a target to gain points or hide in "safe areas" to escape or avoid on-screen aversive events. Results show that participants with PTSS exhibited more avoidance across trials than noPTSS participants, particularly due to more avoidance behavior in PTSS females compared to noPTSS females. Avoidance behavior decreased across extinction trials but interactions with PTSS and gender fell short of significance. Overall, PTSD symptoms were associated with propensity to acquire and express avoidance behavior, in both civilians and veterans, and even in a cognitive task that does not explicitly involve trauma or fear. This effect was more pronounced in females, highlighting the role of gender differences in PTSD symptomatology. Importantly, this study also demonstrates the potential of an objective assessment of avoidance behavior, which could be used to supplement the common but limited self-report tools.

Predictors of avoiding medical care and reasons for avoidance behavior.

PubMed

Kannan, Viji Diane; Veazie, Peter J

2014-04-01

Delayed medical care has negative health and economic consequences; interventions have focused on appraising symptoms, with limited success in reducing delay. To identify predictors of care avoidance and reasons for avoiding care. Using the Health Information National Trends Survey (2007), we conducted logistic regressions to identify predictors of avoiding medical visits deemed necessary by the respondents; and, we then conducted similar analyses on reasons given for avoidance behavior. Independent variables included geographic, demographic, socioeconomic, personal health, health behavior, health care system, and cognitive characteristics. Approximately one third of adults avoided doctor visits they had deemed necessary. Although unadjusted associations existed, avoiding needed care was not independently associated with geographic, demographic, and socioeconomic characteristics. Avoidance behavior is characterized by low health self-efficacy, less experience with both quality care and getting help with uncertainty about health, having your feelings attended to by your provider, no usual source of care, negative affect, smoking daily, and fatalistic attitude toward cancer. Reasons elicited for avoidance include preference for self-care or alternative care, dislike or distrust of doctors, fear or dislike of medical treatments, time, and money; respondents also endorsed discomfort with body examinations, fear of having a serious illness, and thoughts of dying. Distinct predictors distinguish each of these reasons. Interventions to reduce patient delay could be improved by addressing the health-related behavioral, belief, experiential, and emotional traits associated with delay. Attention should also be directed toward the interpersonal communications between patients and providers.

Avoiding Mathematics Trauma: Alternative Teaching Methods.

ERIC Educational Resources Information Center

Ufuktepe, Unal; Ozel, Claire Thomas

Children in primary education often encounter mathematics having picked up a general fear of mathematics from the society around them. This results in lack of confidence, avoidance of non-standard thought processes, weakness in problem solving strategies, and other negative consequences. This study offers an alternative approach: presenting…

Reliability and validity of the Persian versions of the fear avoidance beliefs questionnaire and Tampa Scale of Kinesiophobia in patients with neck pain.

PubMed

Askary-Ashtiani, Ahmadreza; Ebrahimi-Takamejani, Ismail; Torkaman, Giti; Amiri, Mohsen; Mousavi, Seyed Javad

2014-08-15

Validation of 2 self-report questionnaires. To evaluate the internal consistency, reliability, and construct validity of the Persian versions of the fear avoidance beliefs questionnaire (FABQ) and the Tampa Scale of Kinesiophobia (TSK) in patients with acute and chronic neck pain. The FABQ and TSK are 2 important measures to evaluate fear of pain and fear avoidance beliefs in patients with spinal pain. To date, the psychometric properties of these questionnaires have not been demonstrated in Persian-speaking patients with neck pain in Iran. One hundred sixty-six patients with acute and chronic neck pain participated in the study. The construct validity of the questionnaires was evaluated by measuring convergent and known-groups validity. The visual analogue scale measure of pain, neck disability index, hospital anxiety and depression scale, and the physical (PCS-12) and mental (MCS-12) summary scores of the Short Form health survey (SF-12) were used to test construct validity of the Persian FABQ and TSK. In addition, 50 randomly selected patients with chronic neck pain were asked to complete the questionnaires 48 hours later for the second time. Cronbach α coefficient for the FABQ and TSK in patients with acute and chronic pain was in the range from 0.77 to 0.92 and 0.77 to 0.78, respectively. The Persian FABQ and TSK showed satisfactory test-retest reliability with intraclass correlation coefficient of more than 0.80. There were moderate to strong correlations between the Persian FABQ and TSK scores and the neck disability index (r = 0.44-0.55), Depression subscales of the hospital anxiety and depression scale (r = 0.42-0.48), and PCS-12 (r =-0.34 to -0.62). The Persian FABQ and TSK have acceptable reliability and validity for measuring pain related fear and avoidance beliefs among Persian-speaking patients with acute and chronic neck pain. However, considering the study limitations, the findings should be interpreted with caution. 3.

[Pain and fear of movement in the elderly : the need for an interdisciplinary approach].

PubMed

Leonhardt, C; Laekeman, M

2010-12-01

According to evidence-based guidelines a physically activating therapy approach in older chronic pain patients is necessary for the preservation of autonomy. Often the elderly are not easy to motivate for this because of inappropriate attitudes, low self-efficacy, fear of pain and fear of falling. The latter might be more important for self-induced restriction of activity in older pain patients than fear avoidance beliefs known from pain research. The fear of caregivers concerning pain and falls can also lead to physical restrictions in the elderly. The underlying diseases and drug effects have to be borne in mind in exercise-oriented therapy. It seems necessary to design special therapy elements for all national care sectors using age-specific motivation strategies and to assure an interdisciplinary cooperation.

Parasites, info-disruption, and the ecology of fear.

PubMed

Rohr, Jason R; Swan, Autumn; Raffel, Thomas R; Hudson, Peter J

2009-03-01

There is growing interest in the ecological consequences of fear, as evidenced by the numerous studies on the nonconsumptive, trait-mediated effects of predators. Parasitism, however, has yet to be fully integrated into research on the ecology of fear, despite it having direct negative and often lethal effects on hosts and being the most common life history strategy on the planet. This might at least be partly due to the traditional, but untested, assumption that anti-parasite responses are weak relative to anti-predator responses. To test this hypothesis, we quantified the activity and location responses of Bufo americanus tadpoles to one of six chemical cues: water; cercariae of Echinostoma trivolvis, a trematode which infects and can kill amphibians; a snail releasing E. trivolvis cercariae; an uninfected snail; food; or conspecific alarm chemicals signaling predation. There is also literature encouraging research on the context dependency and pollution-induced disruption of fear responses. Consequently, before quantifying responses to the chemical cues, half of the B. americanus were exposed to the herbicide atrazine (201 microg/l for 4 days), a reported inhibitor of fear responses in fish. Tadpoles were attracted to food, were indifferent to an uninfected snail, avoided alarm chemicals, and exhibited avoidance and elevated activity in response to a snail shedding cercariae and cercariae alone. Atrazine had no detectable effects on B. americanus' responses to the tested cues despite the use of a higher concentration and longer exposure duration than has been repeatedly shown to inhibit chemical cue detection in fish. The magnitude of anti-parasite and anti-predator responses were qualitatively similar, suggesting that the fear of disease and its ecological consequences could be comparable to that of predation. Consequently, we call for a greater integration of parasites into research on the ecology of fear and trait-mediated indirect effects.

Need and Demand for Sedation or General Anesthesia in Dentistry: A National Survey of the Canadian Population

PubMed Central

Chanpong, B; Haas, D. A; Locker, D

2005-01-01

The aim of this study was to assess the need and demand for sedation or general anesthesia (GA) for dentistry in the Canadian adult population. A national telephone survey of 1101 Canadians found that 9.8% were somewhat afraid of dental treatment, with another 5.5% having a high level of fear. Fear or anxiety was the reason why 7.6% had ever missed, cancelled, or avoided a dental appointment. Of those with high fear, 49.2% had avoided a dental appointment at some point because of fear or anxiety as opposed to only 5.2% from the no or low fear group. Regarding demand, 12.4% were definitely interested in sedation or GA for their dentistry and 42.3% were interested depending on cost. Of those with high fear, 31.1% were definitely interested, with 54.1% interested depending on cost. In a hypothetical situation where endodontics was required because of a severe toothache, 12.7% reported high fear. This decreased to 5.4% if sedation or GA were available. For this procedure, 20.4% were definitely interested in sedation or GA, and another 46.1% were interested depending on cost. The prevalence of, and preference for, sedation or GA was assessed for specific dental procedures. The proportion of the population with a preference for sedation or GA was 7.2% for cleaning, 18% for fillings or crowns, 54.7% for endodontics, 68.2% for periodontal surgery, and 46.5% for extraction. For each procedure, the proportion expressing a preference for sedation or GA was significantly greater than the proportion having received treatment with sedation or GA (P < 0.001). In conclusion, this study demonstrates that there is significant need and demand for sedation and GA in the Canadian adult population. PMID:15859442

Need and demand for sedation or general anesthesia in dentistry: a national survey of the Canadian population.

PubMed

Chanpong, B; Haas, D A; Locker, D

2005-01-01

The aim of this study was to assess the need and demand for sedation or general anesthesia (GA) for dentistry in the Canadian adult population. A national telephone survey of 1101 Canadians found that 9.8% were somewhat afraid of dental treatment, with another 5.5% having a high level of fear. Fear or anxiety was the reason why 7.6% had ever missed, cancelled, or avoided a dental appointment. Of those with high fear, 49.2% had avoided a dental appointment at some point because of fear or anxiety as opposed to only 5.2% from the no or low fear group. Regarding demand, 12.4% were definitely interested in sedation or GA for their dentistry and 42.3% were interested depending on cost. Of those with high fear, 31.1% were definitely interested, with 54.1% interested depending on cost. In a hypothetical situation where endodontics was required because of a severe toothache, 12.7% reported high fear. This decreased to 5.4% if sedation or GA were available. For this procedure, 20.4% were definitely interested in sedation or GA, and another 46.1% were interested depending on cost. The prevalence of, and preference for, sedation or GA was assessed for specific dental procedures. The proportion of the population with a preference for sedation or GA was 7.2% for cleaning, 18% for fillings or crowns, 54.7% for endodontics, 68.2% for periodontal surgery, and 46.5% for extraction. For each procedure, the proportion expressing a preference for sedation or GA was significantly greater than the proportion having received treatment with sedation or GA (P < 0.001). In conclusion, this study demonstrates that there is significant need and demand for sedation and GA in the Canadian adult population.

Consistency of Fear of Failure Score Meanings among 8- to 18-Year-Old Female Athletes

ERIC Educational Resources Information Center

Conroy, David E.; Coatsworth, J. Douglas; Kaye, Miranda P.

2007-01-01

Fear of failure (FF) energizes individuals to avoid failure because of the learned aversive consequences of failing (e.g., shame). Although FF is socialized in childhood, little is known about the meaning of scores from FF measures used with children and adolescents. This study addresses that void by establishing a preliminary nomological network…

Not Like Us: Using Picture Books to Talk about Relational Bullying

ERIC Educational Resources Information Center

Pace, Barbara G.; Lowery, Ruth M.; Lamme, Linda L.

2004-01-01

Often the victims of bullying are singled out because they are different from the majority. The fear of being bullied is a life-shaping fear that effects the lives of more than 160,000 students who miss school every day to avoid victimization by bullies. The damaging effects of bullying can lead to poor academic performance, low self-esteem, early…

Low back pain patients' responses to videos of avoided movements.

PubMed

Pincus, T; Henderson, J

2013-02-01

Fear avoidance (FA) has been identified as a risk factor for poor prognosis and a target for intervention in patients with low back pain (LBP), but the mechanisms involved need clarification. Experimental studies would benefit from the use of carefully developed and controlled stimuli representing avoided movements in back pain, and matched stimuli of movements to provide a credible control stimuli. Existing stimuli depicting avoided movements in LBP are static, do not include a set of control stimuli and do not control for possible systematic observer biases. Two studies were carried out aiming to develop and test LBP patients' responses to videos of models depicting commonly avoided movements associated with back pain, and those associated with a control condition, wrist pain. Two samples of LBP patients rated how much pain and harm each movement would cause them. They also reported how often they avoided the movement. The findings from the first study (n = 99) indicate that using videos of commonly avoided movements in low back pain is viable, and that movements associated with wrist pain provide an acceptable control stimuli. Participants in the second study (n = 85) consistently rated movements depicted by females as causing more harm, and more frequently avoided than the same movements depicted by males. The use of video stimuli could advance research into the processes associated with FA through experimental paradigms. However, although small, the model gender effects should be carefully considered. © 2012 European Federation of International Association for the Study of Pain Chapters.

A model of differential amygdala activation in psychopathy.

PubMed

Moul, Caroline; Killcross, Simon; Dadds, Mark R

2012-10-01

This article introduces a novel hypothesis regarding amygdala function in psychopathy. The first part of this article introduces the concept of psychopathy and describes the main cognitive and affective impairments demonstrated by this population; that is, a deficit in fear-recognition, lower conditioned fear responses and poor performance in passive avoidance, and response-reversal learning tasks. Evidence for amygdala dysfunction in psychopathy is considered with regard to these deficits; however, the idea of unified amygdala function is untenable. A model of differential amygdala activation in which the basolateral amygdala (BLA) is underactive while the activity of the central amygdala (CeA) is of average to above average levels is proposed to provide a more accurate and up-to-date account for the specific cognitive and emotional deficits found in psychopathy. In addition, the model provides a mechanism by which attentional-based models and emotion-based models of psychopathy can coexist. Data to support the differential amygdala activation model are provided from studies from both human and animal research. Supporting evidence concerning some of the neurochemicals implicated in psychopathy is then reviewed. Implications of the model and areas of future research are discussed. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Attentional avoidance of fearful facial expressions following early life stress is associated with impaired social functioning.

PubMed

Humphreys, Kathryn L; Kircanski, Katharina; Colich, Natalie L; Gotlib, Ian H

2016-10-01

Early life stress is associated with poorer social functioning. Attentional biases in response to threat-related cues, linked to both early experience and psychopathology, may explain this association. To date, however, no study has examined attentional biases to fearful facial expressions as a function of early life stress or examined these biases as a potential mediator of the relation between early life stress and social problems. In a sample of 154 children (ages 9-13 years) we examined the associations among interpersonal early life stressors (i.e., birth through age 6 years), attentional biases to emotional facial expressions using a dot-probe task, and social functioning on the Child Behavior Checklist. High levels of early life stress were associated with both greater levels of social problems and an attentional bias away from fearful facial expressions, even after accounting for stressors occurring in later childhood. No biases were found for happy or sad facial expressions as a function of early life stress. Finally, attentional biases to fearful faces mediated the association between early life stress and social problems. Attentional avoidance of fearful facial expressions, evidenced by a bias away from these stimuli, may be a developmental response to early adversity and link the experience of early life stress to poorer social functioning. © 2016 Association for Child and Adolescent Mental Health.

The development of fears of compassion scale Japanese version.

PubMed

Asano, Kenichi; Tsuchiya, Masao; Ishimura, Ikuo; Lin, Shuzhen; Matsumoto, Yuki; Miyata, Haruko; Kotera, Yasuhiro; Shimizu, Eiji; Gilbert, Paul

2017-01-01

Cultivation of compassion is a useful way to treat mental problems, but some individuals show resistance. Fears of compassion can be an obstacle for clinicians when providing psychotherapy, and for clients when engaging in interpersonal relationships. Despite its importance, a Japanese version of fears of compassion scales (for others, from others, and for self) has not yet been developed. This study developed a Japanese version of the Fears of Compassion Scales and tested its reliability and validity. This study used a cross-sectional design, and a self-report procedure for collecting data. A total of 485 students (121 males and 364 females) answered self-report questionnaires, including the draft Fears of Compassion Scales-Japanese version. There were distinctive factor structures for fear of compassion from others, and for self. The fear of compassion from others scale consisted of concern about compassion from others and avoidance of compassion from others. All scales had good internal consistency, test-retest reliability, face validity, and construct validity. Discrimination and difficulty were also calculated. These results indicate that the Fears of Compassion Scales-Japanese version is a well-constructed and useful measure to assess fears of compassion and the existence of cultural differences in fears of compassion.

Attachment style and adjustment to divorce.

PubMed

Yárnoz-Yaben, Sagrario

2010-05-01

Divorce is becoming increasingly widespread in Europe. In this study, I present an analysis of the role played by attachment style (secure, dismissing, preoccupied and fearful, plus the dimensions of anxiety and avoidance) in the adaptation to divorce. Participants comprised divorced parents (N = 40) from a medium-sized city in the Basque Country. The results reveal a lower proportion of people with secure attachment in the sample group of divorcees. Attachment style and dependence (emotional and instrumental) are closely related. I have also found associations between measures that showed a poor adjustment to divorce and the preoccupied and fearful attachment styles. Adjustment is related to a dismissing attachment style and to the avoidance dimension. Multiple regression analysis confirmed that secure attachment and the avoidance dimension predict adjustment to divorce and positive affectivity while preoccupied attachment and the anxiety dimension predicted negative affectivity. Implications for research and interventions with divorcees are discussed.

The relative effectiveness of extinction and counter-conditioning in diminishing children's fear.

PubMed

Newall, Carol; Watson, Tiffany; Grant, Kerry-Ann; Richardson, Rick

2017-08-01

Two behavioural strategies for reducing learned fear are extinction and counter-conditioning, and in this study we compared the relative effectiveness of the two procedures at diminishing fear in children. Seventy-three children aged 7-12 years old (M = 9.30, SD = 1.62) were exposed to pictures of two novel animals on a computer screen during the fear acquisition phase. One of these animals was paired with a picture of a scared human face (CS+) while the other was not (CS-). The children were then randomly assigned to one of three conditions: counter-conditioning (animal paired with a happy face), extinction (animal without scared face), or control (no fear reduction procedure). Changes in fear beliefs and behavioural avoidance of the animal were measured. Counter-conditioning was more effective at reducing fear to the CS + than extinction. The findings are discussed in terms of implications for behavioural treatments of childhood anxiety disorders. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Types of Dental Fear as Barriers to Dental Care among African American Adults with Oral Health Symptoms in Harlem

PubMed Central

Siegel, Karolynn; Schrimshaw, Eric W.; Kunzel, Carol; Wolfson, Natalie H.; Moon-Howard, Joyce; Moats, Harmon L.; Mitchell, Dennis A.

2013-01-01

To examine the types of dental fear experienced by African American adults and the role of these fears in the utilization of dental care, in-depth interviews were conducted with a street-intercept sample of 118 African Americans living in Harlem, New York City, who had experienced at least one oral health symptom in the past six months. Despite their oral symptoms, participants delayed or avoided dental care (often for years) due to a variety of dental fears, including fears of: 1) pain from needles; 2) the dental drill; 3) having teeth extracted; 4) contracting an illness (e.g., HIV/AIDS) from unsanitary instruments; 5) X-rays; 6) receiving poor quality care or mistreatment. These findings provide insights into the situations that provoke fears about dental treatment among African Americans and suggest strategies to address these fears in order to remove these barriers and increase the utilization of dental care by African American adults. PMID:24212175

Rethinking the role of worry in generalized anxiety disorder: evidence supporting a model of emotional contrast avoidance.

PubMed

Llera, Sandra J; Newman, Michelle G

2014-05-01

The Contrast Avoidance model (Newman & Llera, 2011) proposes that individuals with generalized anxiety disorder (GAD) are hypersensitive to sharp upward shifts in negative emotion that typically accompany negative events, and use worry to maintain sustained intrapersonal negativity in an attempt to avoid these shifts. Although research shows that worry increases negative emotionality and mutes further emotional reactivity to a stressor when compared to the worry period (e.g., Llera & Newman, 2010), no study has tracked changes in negative emotionality from baseline to worry inductions followed by a range of emotional exposures. Further, no study has yet assessed participants' subjective appraisals of prior worry on helping to cope with such exposures. The present study tested the main tenets of the Contrast Avoidance model by randomly assigning participants with GAD (n=48) and nonanxious controls (n=47) to experience worry, relaxation, and neutral inductions prior to sequential exposure to fearful, sad, and humorous film clips. Both physiological (nonspecific skin conductance responses [NS-SCRs]) and self-reported emotional changes were observed. Results indicated that worry boosted negative emotionality from baseline, which was sustained across negative exposures, whereas low negative emotionality during relaxation and neutral inductions allowed for sharp increases in response to exposures. Furthermore, GAD participants found worry to be more helpful than other conditions in coping with exposures, whereas control participants reported the opposite pattern. Results provide preliminary support for the Contrast Avoidance model. This suggests that treatment should focus on underlying avoidance patterns before attempting to reduce worry behavior. Copyright © 2014. Published by Elsevier Ltd.

Changes in dental fear among Finnish adults: a national survey.

PubMed

Liinavuori, Arja; Tolvanen, Mimmi; Pohjola, Vesa; Lahti, Satu

2016-04-01

The aim of this study was to evaluate changes in dental fear among adult Finns aged 19 years and over at the beginning of the study in 2000-2011 in a nationally representative sample. The study was based on Health 2000 and 2011 Surveys by the National Institute for Health and Welfare in Finland. The Health 2000 Survey used a stratified two-stage cluster sampling design (N = 9 922). Those who participated in 2000 (n = 7 964) were invited to participate in 2011. The number of participants was 3 961. Dental fear was assessed by a single question: 'How afraid are you of visiting a dentist?' (not at all, somewhat, very much). Background variables included were age (categories 30-34, 35-39, 40-44, 45-54, 55-64, 65-74, 75+ years), gender, marital status (nonsingle, single), and education (basic, secondary, higher). To match the population sizes in different areas and thus forming a nationally representative data, the data were weighted based on age, gender, and area. General linear modeling for repeated measures was used to evaluate changes in dental fear and associations with background variables. Between 2000 and 2011, dental fear decreased more often than increased among adults in Finland. Change from being very afraid to not at all afraid of visiting a dentist was most common in the oldest group. For most participants, dental fear remained stable; being very afraid of visiting a dentist was more stable among participants from 35 to 54 years of age than among younger or older participants. Dental fear is still common among adult Finns and it seems to depend on age. As the most obvious consequence of dental fear is avoidance of dental care, reducing dental fear should be taken into account when planning and reorienting oral healthcare services. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Achievement goals as mediators of the relationship between competence beliefs and test anxiety.

PubMed

Putwain, David W; Symes, Wendy

2012-06-01

Previous work suggests that the expectation of failure is related to higher test anxiety and achievement goals grounded in a fear of failure. To test the hypothesis, based on the work of Elliot and Pekrun (2007), that the relationship between perceived competence and test anxiety is mediated by achievement goal orientations. Self-report data were collected from 275 students in post-compulsory education following courses in A Level Psychology. Competence beliefs were inversely related to the worry and tension components of test anxiety, both directly and indirectly through a performance-avoidance goal orientation. A mastery-avoidance goal orientation offered an indirect route from competence beliefs to worry only. These findings provide partial support for Elliot and Pekrun's (2007) model. Although significant mediating effects were found for mastery-avoidance and performance-avoidance goals, they were small and there may be other mechanisms to account for the relations between competence beliefs and test anxiety. ©2011 The British Psychological Society.

Understanding shame in adults: retrospective perceptions of parental-bonding during childhood.

PubMed

Lutwak, N; Ferrari, J R

1997-10-01

The association between perceptions of parental-bonding style during childhood and moral affect of shame at young adulthood were examined with 264 women and 140 men (mean age [+/- SD] = 20.4 +/- 1.6 years old). Shame affect was significantly positively related to fear of negative evaluation by others and social avoidance, and negatively related to recalled parental care in one's childhood. Multiple regression analyses indicated that maternal protectiveness, paternal care, fear of negative social evaluation, and social avoidance were significant predictors of shame, explaining 41% of the variance. Results support object relations theory, which states that shame is a moral affect associated with social evaluation apprehension and may have developmental implications for one's parental relations.

A multi-component cognitive behavioural intervention for the treatment of fear of falling after hip fracture (FIT-HIP): protocol of a randomised controlled trial.

PubMed

Scheffers-Barnhoorn, Maaike N; van Haastregt, Jolanda C M; Schols, Jos M G A; Kempen, Gertrudis I J M; van Balen, Romke; Visschedijk, Jan H M; van den Hout, Wilbert B; Dumas, Eve M; Achterberg, Wilco P; van Eijk, Monica

2017-03-20

Hip fracture is a common injury in the geriatric population. Despite surgical repair and subsequent rehabilitation programmes, functional recovery is often limited, particularly in individuals with multi-morbidity. This leads to high care dependency and subsequent use of healthcare services. Fear of falling has a negative influence on recovery after hip fracture, due to avoidance of activity and subsequent restriction in mobility. Although fear of falling is highly prevalent after hip fracture, no structured treatment programme is currently available. This trial will evaluate whether targeted treatment of fear of falling in geriatric rehabilitation after hip fracture using a multi-component cognitive behavioural intervention (FIT-HIP), is feasible and (cost) effective in reducing fear of falling and associated activity restriction and thereby improves physical functioning. This multicentre cluster randomised controlled trial will be conducted among older patients with hip fracture and fear of falling who are admitted to a multidisciplinary inpatient geriatric rehabilitation programme in eleven post-acute geriatric rehabilitation units. Fifteen participants will be recruited from each site. Recruitment sites will be allocated by computer randomisation to either the control group, receiving usual care, or to the intervention group receiving the FIT-HIP intervention in addition to usual care. The FIT-HIP intervention is conducted by physiotherapists and will be embedded in usual care. It consists of various elements of cognitive behavioural therapy, including guided exposure to feared activities (that are avoided by the participants). Participants and outcome assessors are blinded to group allocation. Follow-up measurements will be performed at 3 and 6 months after discharge from geriatric rehabilitation. (Cost)-effectiveness and feasibility of the intervention will be evaluated. Primary outcome measures are fear of falling and mobility. Targeted treatment of fear of falling may improve recovery and physical and social functioning after hip fracture, thereby offering benefits for patients and reducing healthcare costs. Results of this study will provide insight into whether fear of falling is modifiable in the (geriatric) rehabilitation after hip fracture and whether the intervention is feasible. Netherlands Trial Register: NTR 5695 .

Neurocircuit function in eating disorders.

PubMed

Friederich, Hans-Christoph; Wu, Mudan; Simon, Joe J; Herzog, Wolfgang

2013-07-01

Eating disorders are serious psychosomatic disorders with high morbidity and lifetime mortality. Inadequate response to current therapeutic interventions constitutes a challenging clinical problem. A better understanding of the underlying neurobiological mechanisms could improve psychotherapeutic and drug treatment strategies. A review highlighting the current state of brain imaging in eating disorders related to the anxiety and pathological fear learning model of anorexia nervosa (AN) and the impulsivity model of binge eating in bulimia nervosa (BN). Available neuroimaging studies in patients with acute AN primarily suggest a hyper-responsive emotional and fear network to food, but not necessarily to eating disorder-unrelated, salient stimuli. Furthermore, patients with AN show decreased activation in the ventral fronto-striatal circuits during the performance of a cognitive flexibility task. Results in patients with BN primarily suggest a hypo-responsive reward system to food stimuli, especially to taste reward. Additionally, patients with BN exhibit impaired brain activation in the inhibitory control network during the performance of general response-inhibition tasks. Anxiety and pathological fear learning may lead to conditioned neural stimulus-response patterns to food stimuli and increased cognitive rigidity, which could account for the phobic avoidance of food intake in patients with acute AN. However, further neurobiological studies are required to investigate pathological fear learning in patients with AN. Patients with BN may binge eat to compensate for a hypo-responsive reward system. The impaired brain activation in the inhibitory control network may facilitate the loss of control over food intake in patients with BN. Copyright © 2013 Wiley Periodicals, Inc.

Delaying in vivo exposure to a tarantula with very brief exposure to phobic stimuli.

PubMed

Siegel, Paul; Gallagher, Kimberly Alyse

2015-03-01

Research has documented the very brief exposure (VBE) effect: the reduction of phobic fear by continuous presentation of masked phobic pictures. In prior studies, phobic participants approached a live tarantula immediately after the masked stimuli were presented. This study tested the hypothesis that VBE would reduce phobic avoidance of the tarantula 24 h later. 86 spider-phobic participants were identified with a fear questionnaire and Behavioral Avoidance Test (BAT) with a live tarantula indicative of a DSM-IV diagnosis of Specific Phobia. One week later, they were randomly assigned in double-blind fashion to presentation of a continuous series of 25 trials of masked images of either spiders or flowers (33-ms each), i.e., to VBE or control exposure. The participants gave subjective distress ratings just before and after these exposures. Then they engaged in the BAT again either immediately thereafter or 24 h later to measure changes in avoidance of the tarantula. Masked images of spiders reduced avoidance of the tarantula both immediately after exposure and 24 h later without causing subjective distress. The effect sizes at these two time points did not significantly differ from each other. We did not manipulate awareness of the spider images by presenting them unmasked to a third group. Conclusions about the effect of awareness of the stimuli cannot be drawn. VBE induces a process of fear reduction before phobic individuals engage in in vivo exposure, which is more distressing. Thus, VBE may help phobic-resistant individuals start treatment more gradually.

Returning to work following low back pain: towards a model of individual psychosocial factors.

PubMed

Besen, Elyssa; Young, Amanda E; Shaw, William S

2015-03-01

The aim of this paper is to develop and test a model of direct and indirect relationships among individual psychosocial predictors of return-to-work (RTW) outcomes following the onset of low back pain (LBP). We utilize secondary analysis of a larger study of adults seeking treatment for work-related LBP with recent onset. In total, 241 participants who completed a baseline survey, a short follow-up survey, and a longer follow-up survey after 3 months were included in our analyses. The participants were required to have LBP with onset of less than 14 days, be 18 years or older, and be fluent in English or Spanish. The analyses utilized structural equation models to test the direct and indirect relationships among the variables and RTW outcomes at 3 months. Our results indicated a good fit for our model (χ2 = 69.59, df = 45, p < .05; RMSEA = .05; CFI = .95; WRMR = .61). Pain, catastrophizing, fear-avoidance beliefs, organizational support, and RTW confidence were all found to have indirect relationships with the outcomes. RTW confidence and RTW expectations were found to have direct relationships with the outcomes. The process of returning to work after an episode of LBP is a complex process involving many interrelated factors. Understanding the relationships among critical individual factors in the RTW process may be important for the treatment and rehabilitation of those with LBP. Results suggest that if injured workers are struggling with fear avoidance, pain catastrophizing and confidence issues, they might benefit from the application of cognitive behavioral therapy techniques.

Development and validation of two measures of emotional contrast avoidance: The contrast avoidance questionnaires.

PubMed

Llera, Sandra J; Newman, Michelle G

2017-06-01

The Contrast Avoidance (CA) model (Newman & Llera, 2011) proposed that individuals with generalized anxiety disorder (GAD) fear sharp emotional shifts (or contrasts), such as the shift from a pleasant or neutral state to one of sudden distress following a negative event. Further, the model suggests that chronic worry is employed by those with GAD to sustain negative emotionality as a means to avoid sudden shifts into negativity. The model has received empirical support; however, no validated measure exists to assess CA tendencies. In this paper we developed and tested two measures of CA: one focusing on worry, and another examining broader mechanisms of CA that could be used test whether CA is applicable to other disorders. In Study 1, Part 1, we used 3 samples of participants (each N=410) to perform item reduction, exploratory factor analysis, and confirmatory factor analysis. In Study 1, Part 2, we performed tests of construct validity. In Study 2, we used a new sample (N=126) to determine test-retest reliability. All data point to the strong psychometric properties of the CA questionnaires and their relationship to GAD. Both measures distinguished between participants reporting clinical levels of GAD symptoms and nonanxious controls, demonstrating their utility as complementary measures of CA tendencies. Copyright © 2017 Elsevier Ltd. All rights reserved.

How to Modify (Implicit) Evaluations of Fear-Related Stimuli: Effects of Feature-Specific Attention Allocation

PubMed Central

Vanaelst, Jolien; Spruyt, Adriaan; De Houwer, Jan

2016-01-01

We demonstrate that feature-specific attention allocation influences the way in which repeated exposure modulates implicit and explicit evaluations toward fear-related stimuli. During an exposure procedure, participants were encouraged to assign selective attention either to the evaluative meaning (i.e., Evaluative Condition) or a non-evaluative, semantic feature (i.e., Semantic Condition) of fear-related stimuli. The influence of the exposure procedure was captured by means of a measure of implicit evaluation, explicit evaluative ratings, and a measure of automatic approach/avoidance tendencies. As predicted, the implicit measure of evaluation revealed a reduced expression of evaluations in the Semantic Condition as compared to the Evaluative Condition. Moreover, this effect generalized toward novel objects that were never presented during the exposure procedure. The explicit measure of evaluation mimicked this effect, although it failed to reach conventional levels of statistical significance. No effects were found in terms of automatic approach/avoidance tendencies. Potential implications for the treatment of anxiety disorders are discussed. PMID:27242626

Relational Anxiety and Sexting.

PubMed

Weisskirch, Robert S; Drouin, Michelle; Delevi, Rakel

2017-01-01

Individuals in pursuit of, or currently in, a romantic relationship typically communicate via technology, extending to sexting with one another. Sexting is commonly understood as the sending and receiving of sexually suggestive or sexually explicit photos, video, or text via cell phone or other technologies. The characteristics that fuel whether one engages in sexting are not well understood. In this study, 459 unmarried, heterosexual undergraduate students (female = 328; male = 131), aged 18 to 25 years, from three universities completed an online questionnaire about their behaviors with technology and romantic relationships. In general, low attachment avoidance and high fear of negative evaluation from the dating partner predicted sending a sexually suggestive photo or video, sending a photo or video in one's underwear or lingerie, and sending a sexually suggestive text. High fear of negative evaluation predicted sending a nude photo or video as well as sending a text message propositioning sex. Low attachment avoidance, greater fear of negative evaluation, and greater social distress when dating were associated with sexting behaviors.

How to Modify (Implicit) Evaluations of Fear-Related Stimuli: Effects of Feature-Specific Attention Allocation.

PubMed

Vanaelst, Jolien; Spruyt, Adriaan; De Houwer, Jan

2016-01-01

We demonstrate that feature-specific attention allocation influences the way in which repeated exposure modulates implicit and explicit evaluations toward fear-related stimuli. During an exposure procedure, participants were encouraged to assign selective attention either to the evaluative meaning (i.e., Evaluative Condition) or a non-evaluative, semantic feature (i.e., Semantic Condition) of fear-related stimuli. The influence of the exposure procedure was captured by means of a measure of implicit evaluation, explicit evaluative ratings, and a measure of automatic approach/avoidance tendencies. As predicted, the implicit measure of evaluation revealed a reduced expression of evaluations in the Semantic Condition as compared to the Evaluative Condition. Moreover, this effect generalized toward novel objects that were never presented during the exposure procedure. The explicit measure of evaluation mimicked this effect, although it failed to reach conventional levels of statistical significance. No effects were found in terms of automatic approach/avoidance tendencies. Potential implications for the treatment of anxiety disorders are discussed.

Task-irrelevant spider associations affect categorization performance.

PubMed

Woud, Marcella L; Ellwart, Thomas; Langner, Oliver; Rinck, Mike; Becker, Eni S

2011-09-01

In two studies, the Single Target Implicit Association Test (STIAT) was used to investigate automatic associations toward spiders. In both experiments, we measured the strength of associations between pictures of spiders and either threat-related words or pleasant words. Unlike previous studies, we administered a STIAT version in which stimulus contents was task-irrelevant: The target spider pictures were categorized according to the label picture, irrespective of what they showed. In Study 1, spider-fearful individuals versus non-fearful controls were tested, Study 2 compared spider enthusiasts to non-fearful controls. Results revealed that the novel STIAT version was sensitive to group differences in automatic associations toward spiders. In Study 1, it successfully distinguished between spider-fearful individuals and non-fearful controls. Moreover, STIAT scores predicted automatic fear responses best, whereas controlled avoidance behavior was best predicted by the FAS (German translation of the Fear of Spiders Questionnaire). The results of Study 2 demonstrated that the novel STIAT version was also able to differentiate between spider enthusiasts and non-fearful controls. Copyright © 2010 Elsevier Ltd. All rights reserved.

Teachers' use of fear appeals in the mathematics classroom: worrying or motivating students?

PubMed

Putwain, David W; Symes, Wendy

2011-09-01

AIM. This study examined whether teachers' use of fear appeals in the classroom, attempts to motivate students to perform well in high-stakes examinations by highlighting the educational, and/or occupational consequences of failure did indeed motivate students or whether it contributed to an increase in worry, anxiety, and fear of failure. SAMPLE. A total of 132 secondary school students. METHOD. Self-report data were collected for teachers' use of fear appeals, test anxiety, and achievement goals in the context of Mathematics at the end of Years 10 and 11, the final 2 years of compulsory schooling. RESULTS. The frequency with which teachers were reported to make fear appeals was unrelated to future test anxiety and achievement goals. When fear appeals were perceived to be threatening, however, they were related to an increase in the worry and tension components of test anxiety and increases in performance-avoidance and mastery-approach goals. CONCLUSION. Fear appeals appear to have competing positive and negative outcomes, resulting in both anxiety and a fear of failure, and a mastery-approach goal. ©2010 The British Psychological Society.

Increasing Recreational Physical Activity in Patients With Chronic Low Back Pain: A Pragmatic Controlled Clinical Trial.

PubMed

Ben-Ami, Noa; Chodick, Gabriel; Mirovsky, Yigal; Pincus, Tamar; Shapiro, Yair

2017-02-01

Study Design Prospective, pragmatic, nonrandomized controlled clinical trial. Background Clinical guidelines recommend physical activity for the treatment of chronic low back pain. But engaging patients in physical activity has proven difficult. Known obstacles to physical activity include low self-efficacy and fear avoidance. Objectives This study tested the effectiveness of an enhanced transtheoretical model intervention (ETMI) aimed at increasing recreational physical activity in patients with chronic low back pain, in comparison to usual physical therapy. Methods Patients (n = 220) referred to physical therapy for chronic low back pain were allocated to ETMI or to a control group. The ETMI was delivered by physical therapists and based on behavior-change principles, combined with increased reassurance, therapeutic alliance, and exposure to reduce fear avoidance. The primary outcome was back pain-related disability (Roland-Morris Disability Questionnaire). Secondary outcomes included pain intensity, mental and physical health, and levels of physical activity. Results Intention-to-treat analysis in 189 patients at 12 months indicated that patients in the ETMI group had significantly lower disability compared to usual physical therapy. The difference in mean change from baseline between the interventions was 2.7 points (95% confidence interval: 0.9, 4.5) on the Roland-Morris Disability Questionnaire. At 12 months, worst pain, physical activity, and physical health were all significantly better in patients receiving ETMI. The average number of sessions was 3.5 for the ETMI group and 5.1 for controls. Conclusion Targeting obstacles to physical activity with an intervention that includes components to address self-efficacy and fear avoidance appears to be more effective than usual physical therapy care in reducing long-term disability. Further research is needed to explore the mechanisms that impact outcomes in this intervention package. Level of Evidence Therapy, level 2b. Registered June 7, 2012 at ClinicalTrials.gov (NCT01631344). J Orthop Sports Phys Ther 2017;47(2):57-66. doi:10.2519/jospt.2017.7057.

Categorization-based stranger avoidance does not explain the uncanny valley effect.

PubMed

MacDorman, Karl F; Chattopadhyay, Debaleena

2017-04-01

The uncanny valley hypothesis predicts that an entity appearing almost human risks eliciting cold, eerie feelings in viewers. Categorization-based stranger avoidance theory identifies the cause of this feeling as categorizing the entity into a novel category. This explanation is doubtful because stranger is not a novel category in adults; infants do not avoid strangers while the category stranger remains novel; infants old enough to fear strangers prefer photographs of strangers to those more closely resembling a familiar person; and the uncanny valley's characteristic eeriness is seldom felt when meeting strangers. We repeated our original experiment with a more realistic 3D computer model and found no support for categorization-based stranger avoidance theory. By contrast, realism inconsistency theory explains cold, eerie feelings elicited by transitions between instances of two different, mutually exclusive categories, given that at least one category is anthropomorphic: Cold, eerie feelings are caused by prediction error from perceiving some features as features of the first category and other features as features of the second category. In principle, realism inconsistency theory can explain not only negative evaluations of transitions between real and computer modeled humans but also between different vertebrate species. Copyright © 2017 Elsevier B.V. All rights reserved.

Impact of pain characteristics and fear-avoidance beliefs on physical activity levels among older adults with chronic pain: a population-based, longitudinal study.

PubMed

Larsson, Caroline; Ekvall Hansson, Eva; Sundquist, Kristina; Jakobsson, Ulf

2016-02-24

To explore the level of physical activity in a population based sample of older adults; to analyze the influence of pain characteristics and fear-avoidance beliefs as predictors of physical activity among older adults reporting chronic pain. Demographics, pain characteristics (duration, intensity), physical activity, kinesiophobia (excessive fear of movement/(re) injury), self-efficacy and self-rated health were measured with questionnaires at baseline and 12-months later. Logistic regression analyses were done to identify associations at baseline and predictors of physical activity 12-months later during follow-up. Of the 1141 older adults (mean age 74.4 range 65-103 years, 53.5% women) included in the study, 31.1% of those with chronic pain were sufficiently active (scoring ≥ 4 on Grimby's physical activity scale) compared to 56.9% of those without chronic pain. Lower age (OR = 0.93, 95% CI = 0.88-0.99), low kinesiophobia OR = 0.95, 95% CI = 0.91-0.99), and higher activity level at baseline (OR = 10.0, 95% CI = 4.98-20.67) significantly predicted higher levels of physical activity in individuals with chronic pain. The level of physical activity was significantly lower among those with chronic pain and was significantly associated with kinesiophobia. Our findings suggest that fear- avoidance believes plays a more important role in predicting future physical activity levels than pain characteristics. Thus our findings are important to consider when aiming to increase physical activity in older adults that have chronic pain.

Pyrazine Analogues Are Active Components of Wolf Urine That Induce Avoidance and Freezing Behaviours in Mice

PubMed Central

Osada, Kazumi; Kurihara, Kenzo; Izumi, Hiroshi; Kashiwayanagi, Makoto

2013-01-01

Background The common grey wolf (Canis lupus) is found throughout the entire Northern hemisphere and preys on many kinds of mammals. The urine of the wolf contains a number of volatile constituents that can potentially be used for predator–prey chemosignalling. Although wolf urine is put to practical use to keep rabbits, rodents, deer and so on at bay, we are unaware of any prior behavioural studies or chemical analyses regarding the fear-inducing impact of wolf urine on laboratory mice. Methodology/Principal Findings Three wolf urine samples harvested at different times were used in this study. All of them induced stereotypical fear-associated behaviors (i.e., avoidance and freezing) in female mice. The levels of certain urinary volatiles varied widely among the samples. To identify the volatiles that provoked avoidance and freezing, behavioural, chemical, and immunohistochemical analyses were performed. One of the urine samples (sample C) had higher levels of 2,6-dimethylpyrazine (DMP), trimethylpyrazine (TMP), and 3-ethyl-2,5-dimethyl pyrazine (EDMP) compared with the other two urine samples (samples A and B). In addition, sample C induced avoidance and freezing behaviours more effectively than samples A and B. Moreover, only sample C led to pronounced expression of Fos-immunoreactive cells in the accessory olfactory bulb (AOB) of female mice. Freezing behaviour and Fos immunoreactivity were markedly enhanced when the mice were confronted with a mixture of purified DMP, TMP, and EDMP vs. any one pyrazine alone. Conclusions/Significance The current results suggest that wolf urinary volatiles can engender aversive and fear-related responses in mice. Pyrazine analogues were identified as the predominant active components among these volatiles to induce avoidance and freezing behaviours via stimulation of the murine AOB. PMID:23637901

Enriching the hierarchical model of achievement motivation: autonomous and controlling reasons underlying achievement goals.

PubMed

Michou, Aikaterini; Vansteenkiste, Maarten; Mouratidis, Athanasios; Lens, Willy

2014-12-01

The hierarchical model of achievement motivation presumes that achievement goals channel the achievement motives of need for achievement and fear of failure towards motivational outcomes. Yet, less is known whether autonomous and controlling reasons underlying the pursuit of achievement goals can serve as additional pathways between achievement motives and outcomes. We tested whether mastery approach, performance approach, and performance avoidance goals and their underlying autonomous and controlling reasons would jointly explain the relation between achievement motives (i.e., fear of failure and need for achievement) and learning strategies (Study 1). Additionally, we examined whether the autonomous and controlling reasons underlying learners' dominant achievement goal would account for the link between achievement motives and the educational outcomes of learning strategies and cheating (Study 2). Six hundred and six Greek adolescent students (Mage = 15.05, SD = 1.43) and 435 university students (Mage M = 20.51, SD = 2.80) participated in studies 1 and 2, respectively. In both studies, a correlational design was used and the hypotheses were tested via path modelling. Autonomous and controlling reasons underlying the pursuit of achievement goals mediated, respectively, the relation of need for achievement and fear of failure to aspects of learning outcomes. Autonomous and controlling reasons underlying achievement goals could further explain learners' functioning in achievement settings. © 2014 The British Psychological Society.

Measuring Perceptions of Stigmatization by Others for Seeking Psychological Help: Reliability and Validity of a New Stigma Scale with College Students

ERIC Educational Resources Information Center

Vogel, David L.; Wade, Nathaniel G.; Ascheman, Paul L.

2009-01-01

Fear of being stigmatized is the most cited reason why individuals avoid psychotherapy. Conceptually, this fear should be strongest when individuals consider the reactions of those they interact with. Across 5 samples, the authors developed the Perceptions of Stigmatization by Others for Seeking Help (PSOSH) scale. In Sample 1 (N = 985), the 5…

The Perceived-Threat Behavioral Approach Test (PT-BAT): Measuring Avoidance in High-, Mid-, and Low-Spider-Fearful Participants

ERIC Educational Resources Information Center

Cochrane, Andy; Barnes-Holmes, Dermot; Barnes-Holmes, Yvonne

2008-01-01

One hundred twenty female participants, with varying levels of spider fear were asked to complete an automated 8-step perceived-threat behavioral approach test (PT-BAT). The steps involved asking the participants if they were willing to put their hand into a number of opaque jars with an incrementally increasing risk of contact with a spider (none…

Stranger Fear and Early Risk for Social Anxiety in Preschoolers with Fragile X Syndrome Contrasted to Autism Spectrum Disorder

ERIC Educational Resources Information Center

Scherr, Jessica F.; Hogan, Abigail L.; Hatton, Deborah; Roberts, Jane E.

2017-01-01

This study investigated behavioral indicators of social fear in preschool boys with fragile X syndrome (FXS) with a low degree of autism spectrum disorder (ASD) symptoms (FXS-Low; n = 29), FXS with elevated ASD symptoms (FXS-High; n = 25), idiopathic ASD (iASD; n = 11), and typical development (TD; n = 36). Gaze avoidance, escape behaviors, and…

University Students' Perception of People Living with HIV/AIDS: Discomfort, Fear, Knowledge and a Willingness to Care

ERIC Educational Resources Information Center

Houtsonen, Jarmo; Kylmä, Jari; Korhonen, Teija; Välimäki, Maritta; Suominen, Tarja

2014-01-01

People living with HIV/AIDS (PLWHA) are often subject to blame, fear and avoidance, particularly if they are perceived as personally responsible for their infection due to their risky behaviour or life style choices. Some people however, react to PLWHA with sympathy and a willingness to care. This paper explores how university students (n = 282)…

Effectiveness of a combination of cognitive behavioral therapy and task-oriented balance training in reducing the fear of falling in patients with chronic stroke: study protocol for a randomized controlled trial.

PubMed

Liu, Tai-Wa; Ng, Gabriel Y F; Ng, Shamay S M

2018-03-07

The consequences of falls are devastating for patients with stroke. Balance problems and fear of falling are two major challenges, and recent systematic reviews have revealed that habitual physical exercise training alone cannot reduce the occurrence of falls in stroke survivors. However, recent trials with community-dwelling healthy older adults yielded the promising result that interventions with a cognitive behavioral therapy (CBT) component can simultaneously promote balance and reduce the fear of falling. Therefore, the aim of the proposed clinical trial is to evaluate the effectiveness of a combination of CBT and task-oriented balance training (TOBT) in promoting subjective balance confidence, and thereby reducing fear-avoidance behavior, improving balance ability, reducing fall risk, and promoting independent living, community reintegration, and health-related quality of life of patients with stroke. The study will constitute a placebo-controlled single-blind parallel-group randomized controlled trial in which patients are assessed immediately, at 3 months, and at 12 months. The selected participants will be randomly allocated into one of two parallel groups (the experimental group and the control group) with a 1:1 ratio. Both groups will receive 45 min of TOBT twice per week for 8 weeks. In addition, the experimental group will receive a 45-min CBT-based group intervention, and the control group will receive 45 min of general health education (GHE) twice per week for 8 weeks. The primary outcome measure is subjective balance confidence. The secondary outcome measures are fear-avoidance behavior, balance ability, fall risk, level of activities of daily living, community reintegration, and health-related quality of life. The proposed clinical trial will compare the effectiveness of CBT combined with TOBT and GHE combined with TOBT in promoting subjective balance confidence among chronic stroke patients. We hope our results will provide evidence of a safe, cost-effective, and readily transferrable therapeutic approach to clinical practice that reduces fear-avoidance behavior, improves balance ability, reduces fall risk, promotes independence and community reintegration, and enhances health-related quality of life. ClinicalTrials.gov, NCT02937532 . Registered on 17 October 2016.

Emotional intensity reduces later generalized anxiety disorder symptoms when fear of anxiety and negative problem-solving appraisal are low.

PubMed

Sugiura, Yoshinori; Sugiura, Tomoko

2015-08-01

While research based on the emotion dysregulation model indicates a positive relationship between intense emotions and generalized anxiety disorder (GAD) symptoms, emotion-focused intervention involves the use of techniques to enhance emotional experiences, based on the notion that GAD patients are engaging in avoidance strategies. To reveal the conditions under which intense emotions lead to reduced GAD symptoms, we designed a longitudinal study to monitor changes in GAD symptoms among students (N = 129) over 3 months. Our focus was on possible moderators of the effect of emotional intensity. Results indicated that when fear of emotions and negative appraisals about problem solving were low, negative emotional intensity reduced later GAD symptoms. Moreover, under the condition of high responsibility to continue thinking, emotional intensity tended to reduce later GAD symptoms. Results suggest that reduced fear of emotions and reduced negative appraisals about problem solving may enhance the use of emotional processing techniques (e.g., emotional exposure). The interaction between responsibility to continue thinking and emotional intensity requires further examination. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

At issue: siblings of patients with schizophrenia: sibling bond, coping patterns, and fear of possible schizophrenia heredity.

PubMed

Stålberg, Gabriella; Ekerwald, Hedvig; Hultman, Christina M

2004-01-01

Siblings of schizophrenia patients are from the patient's perspective important support providers, but most studies on family burden have focused on the parental role. This study aims to develop a detailed analysis of the psychological aspects of having a sibling with schizophrenia. We did a qualitative study with audiotaped semistructured interviews of 16 siblings. The reliability of the inductive categorization of data was high. A unifying theme appeared to be an emotional sibling bond characterized by feelings of love, sorrow, anger, envy, guilt, and shame. The major categories linked to coping with the situation were avoidance, isolation, normalization, caregiving, and grieving. A third major theme consisted of a fear of possible schizophrenia heredity. The siblings described concerns about the impact of a family history of psychiatric illness, a fear of becoming mentally ill, and reflections about "bad genes." Our findings support earlier findings of coping patterns but complement them by providing a model that includes awareness of genetic vulnerability as an important part of siblings' subjective burden.

The scare tactic: do fear appeals predict motivation and exam scores?

PubMed

Putwain, David; Remedios, Richard

2014-12-01

Prior to high-stakes exams, teachers use persuasive messages that highlight to students the possible consequences of failure. Such messages are known as fear appeals. This study examined whether fear appeals relate to self- and non-self-determined motivation and academic performance. Data were collected in 3 waves. Self-report data pertaining to perceived fear appeals were collected in the first wave, self-report data pertaining to self-determined motivation were collected in the second wave, and exam scores were collected in the third wave. An increased frequency of fear appeals and the appraisal of fear appeals as threatening predicted lower self-determined motivation but were largely unrelated to non-self-determined motivation. An increased frequency of fear appeals and the appraisal of fear appeals as threatening predicted lower examination performance that was partly mediated by lower self-determined motivation. These findings support a position derived from self-worth theory that the negative consequences of fear appeals arise from their focus on avoiding failure rather than their focus on extrinsic consequences. We suggest that teachers and instructors need to be aware how seemingly motivational statements can unwittingly promote lower self-determined motivation. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Attentional Bias to Threat-Related Information Among Individuals With Dental Complaints: The Role of Pain Expectancy.

PubMed

Dehghani, Mohsen; Mohammadi, Somayyeh; Sharpe, Louise; Khatibi, Ali

2018-01-01

Expecting pain can be perceived as a threat may involve recruitment of cognitive strategies (such as attentional avoidance) which might help the person to reduce distress. The ecological validity of the paradigms aiming to study the attentional biases toward or away from threatening stimuli by manipulating the perception of threat in experimental settings has been questioned. Therefore, the current study aims to investigate the attentional bias toward or away from the threat when a confrontation with a real threatening and painful condition would be expected (i.e., dental treatment). One hundred and twenty-seven patients referred to three dentistry clinics for a dental treatment (experiment participants) and 30 individuals with no dental complaints (control participants) completed this study. Patients were randomly allocated to a high pain expectancy (HPE: n = 65) or a low pain expectancy (LPE: n = 62) expectancy condition. All participants completed questionnaires of distress, fear of pain, and fear of dental pain. Furthermore, they participated in a dot-probe task that assessed their attention to painful faces, dental pictures, and happy faces. In addition, before the treatment, participants reported their anticipated pain intensity and after the treatment, they reported the pain intensity that they perceived during the treatment using two separate visual analog scales. Patients in the HPE group showed a bias away from dental pictures compared to LPE and control group participants. HPE group patients also reported greater pain intensity during the treatment compared to LPE patients. Greater attentional bias away from dental pictures among HPE patients was associated with higher levels of fear of pain, fear of dental pain, and stress. Avoidance of highly salient threatening images can be seen as an unhelpful emotion-regulation strategy that individuals use to manage their fears. However, in this study, avoidance was associated with poorer outcomes.

Visually impaired individuals, safety perceptions and traumatic events: a qualitative study of hazards, reactions and coping.

PubMed

Saur, Randi; Hansen, Marianne Bang; Jansen, Anne; Heir, Trond

2017-04-01

To explore the types of risks and hazards that visually impaired individuals face, how they manage potential threats and how reactions to traumatic events are manifested and coped with. Participants were 17 visually impaired individuals who had experienced some kind of potentially traumatic event. Two focus groups and 13 individual interviews were conducted. The participants experienced a variety of hazards and potential threats in their daily life. Fear of daily accidents was more pronounced than fear of disasters. Some participants reported avoiding help-seeking in unsafe situations due to shame at not being able to cope. The ability to be independent was highlighted. Traumatic events were re-experienced through a variety of sense modalities. Fear of labelling and avoidance of potential risks were recurring topics, and the risks of social withdrawal and isolation were addressed. Visual impairment causes a need for predictability and adequate information to increase and prepare for coping and self-efficacy. The results from this study call for greater emphasis on universal design in order to ensure safety and predictability. Fear of being labelled may inhibit people from using assistive devices and adequate coping strategies and seeking professional help in the aftermath of a trauma. Implications for Rehabilitation Visual impairment entails a greater susceptibility to a variety of hazards and potential threats in daily life. This calls for a greater emphasis on universal design in public spaces to ensure confidence and safety. Visual impairment implies a need for predictability and adequate information to prepare for coping and self-efficacy. Rehabilitation professionals should be aware of the need for independence and self-reliance, the possible fear of labelling, avoidance of help-seeking or reluctance to use assistive devices. In rehabilitation after accidents or potential traumatizing events, professionals' knowledge about the needs for information, training and predictability is crucial. The possibility of social withdrawal or isolation should be considered.

Fears of happiness and compassion in relationship with depression, alexithymia, and attachment security in a depressed sample.

PubMed

Gilbert, Paul; McEwan, Kirsten; Catarino, Francisca; Baião, Rita; Palmeira, Lara

2014-06-01

In a non-clinical population, fears of compassion and fear of happiness have both been found to be highly correlated with alexithymia and depression. This study sought to explore these processes and their links with adult attachment and social safeness and pleasure in a depressed group. A total of 52 participants suffering from moderate to severe depression completed measures of fears of happiness, compassion from others and for self, in addition to measures of alexithymia, attachment, social safeness, and depression, anxiety, and stress. Fears of compassion and happiness were highly correlated with alexithymia, adult attachment, and depression, anxiety, and stress. Fear of happiness was found to be the best predictor of depression, anxiety, and stress, whereas fear of compassion from others was the best predictor of adult attachment. A path analysis showed that fears of positive emotion fully mediate the link between alexithymia and depression. This clinical sample had higher mean scores in fears of positive emotions, alexithymia, and depression, anxiety, and stress than a previously studied student sample. This study adds to the evidence that fears of positive emotions are important features of mental health difficulties. Unaddressed, these fears can block positive emotions and may lead to emotional avoidance of positive affect thus contributing as blocks to successful therapy. Therapies for depression may therefore profitably assess and desensitize the fear of positive emotions. © 2013 The British Psychological Society.

A rating instrument for fear of hospitalisation.

PubMed

Jankovic, Slobodan M; Antonijevic, Gordana V; Vasic, Ivana R; Zivkovic-Radojevic, Marija N; Mirkovic, Snjezana N; Nikolic, Bosko V; Opancina, Valentina D; Putnik, Srdjan S; Radoicic, Ljiljana R; Raspopovic, Katarina M; Stanojevic, Dragan R; Teofilov, Sladjana D; Tomasevic, Katarina V; Radonjic, Vesela

2018-04-01

To develop and validate a reliable instrument that can measure fear of hospitalisation experienced by outpatients. After having a diagnosis established, some patients experience sense of fear, unpleasantness and embarrassment due to the possibility to be admitted to a hospital. Currently, there is no available instrument for measuring fear of hospitalisation. Cross-sectional study for assessing reliability and validity of a questionnaire. The questionnaire with 17 items and answers according to the Likert scale was developed during two brainstorming sessions of the research team. Its reliability, validity and temporal stability were tested on the sample of 330 outpatients. The study was multicentric, involving patients from seven cities and three countries. Fear of hospitalisation scale showed satisfactory reliability, when rated both by the investigators (Cronbach's alpha .799) and by the patients themselves (Cronbach's alpha .760). It is temporally stable, and both divergent and convergent validity tests had good results. Factorial analysis revealed three domains: fear of being injured, trust to medical staff and fear of losing privacy or autonomy. This study developed new reliable and valid instrument for measuring fear of hospitalisation. Identification of patients with high level of fear of hospitalisation by this instrument should help clinicians to administer measures which may decrease fear and prevent avoidance of healthcare utilisation. © 2018 John Wiley & Sons Ltd.

The development of fears of compassion scale Japanese version

PubMed Central

Asano, Kenichi; Tsuchiya, Masao; Ishimura, Ikuo; Lin, Shuzhen; Matsumoto, Yuki; Miyata, Haruko; Kotera, Yasuhiro; Shimizu, Eiji; Gilbert, Paul

2017-01-01

Objectives Cultivation of compassion is a useful way to treat mental problems, but some individuals show resistance. Fears of compassion can be an obstacle for clinicians when providing psychotherapy, and for clients when engaging in interpersonal relationships. Despite its importance, a Japanese version of fears of compassion scales (for others, from others, and for self) has not yet been developed. This study developed a Japanese version of the Fears of Compassion Scales and tested its reliability and validity. Design This study used a cross-sectional design, and a self-report procedure for collecting data. Methods A total of 485 students (121 males and 364 females) answered self-report questionnaires, including the draft Fears of Compassion Scales—Japanese version. Results There were distinctive factor structures for fear of compassion from others, and for self. The fear of compassion from others scale consisted of concern about compassion from others and avoidance of compassion from others. All scales had good internal consistency, test-retest reliability, face validity, and construct validity. Discrimination and difficulty were also calculated. Conclusions These results indicate that the Fears of Compassion Scales—Japanese version is a well-constructed and useful measure to assess fears of compassion and the existence of cultural differences in fears of compassion. PMID:29023461

Physical activity and the mediating effect of fear, depression, anxiety, and catastrophizing on pain related disability in people with chronic low back pain.

PubMed

Marshall, Paul W M; Schabrun, Siobhan; Knox, Michael F

2017-01-01

Chronic low back pain is a worldwide burden that is not being abated with our current knowledge and treatment of the condition. The fear-avoidance model is used to explain the relationship between pain and disability in patients with chronic low back pain. However there are gaps in empirical support for pathways proposed within this model, and no evidence exists as to whether physical activity moderates these pathways. This was a cross-sectional study of 218 people with chronic low back pain. Multiple mediation analyses were conducted to determine the role of fear, catastrophizing, depression, and anxiety in the relationship between pain and disability. Separate analyses were performed with physical activity as the moderator. Individuals were classified as performing regular structured physical activity if they described on average once per week for > 30-minutes an activity classified at least moderate intensity (≥ 4-6 METs), activity prescribed by an allied health professional for their back pain, leisure time sport or recreation, or self-directed physical activity such as resistance exercise. Fear, catastrophizing, and depression significantly mediated the relationship between pain and disability (p<0.001). However the mediating effect of catastrophizing was conditional upon weekly physical activity. That is, the indirect effect for catastrophizing mediating the relationship between pain and disability was only significant for individuals reporting weekly physical activity (B = 1.31, 95% CI 0.44 to 2.23), compared to individuals reporting no weekly physical activity (B = 0.21, 95% CI -0.50 to 0.97). Catastrophizing also mediated the relationship between pain and fear (B = 0.37, 95% CI 0.15 to 0.62), with higher scores explaining 53% of the total effect of pain on fear. These results support previous findings about the importance of fear and depression as factors that should be targeted in low back pain patients to reduce back pain related disability. We have also extended understanding for the mediating effect of catastrophizing on back pain related disability. Back pain patients engaged with regular physical activity may require counselling with regards to negative pain perceptions.

Physical activity and the mediating effect of fear, depression, anxiety, and catastrophizing on pain related disability in people with chronic low back pain

PubMed Central

Marshall, Paul W. M.; Schabrun, Siobhan; Knox, Michael F.

2017-01-01

Background Chronic low back pain is a worldwide burden that is not being abated with our current knowledge and treatment of the condition. The fear-avoidance model is used to explain the relationship between pain and disability in patients with chronic low back pain. However there are gaps in empirical support for pathways proposed within this model, and no evidence exists as to whether physical activity moderates these pathways. Methods This was a cross-sectional study of 218 people with chronic low back pain. Multiple mediation analyses were conducted to determine the role of fear, catastrophizing, depression, and anxiety in the relationship between pain and disability. Separate analyses were performed with physical activity as the moderator. Individuals were classified as performing regular structured physical activity if they described on average once per week for > 30-minutes an activity classified at least moderate intensity (≥ 4–6 METs), activity prescribed by an allied health professional for their back pain, leisure time sport or recreation, or self-directed physical activity such as resistance exercise. Results Fear, catastrophizing, and depression significantly mediated the relationship between pain and disability (p<0.001). However the mediating effect of catastrophizing was conditional upon weekly physical activity. That is, the indirect effect for catastrophizing mediating the relationship between pain and disability was only significant for individuals reporting weekly physical activity (B = 1.31, 95% CI 0.44 to 2.23), compared to individuals reporting no weekly physical activity (B = 0.21, 95% CI -0.50 to 0.97). Catastrophizing also mediated the relationship between pain and fear (B = 0.37, 95% CI 0.15 to 0.62), with higher scores explaining 53% of the total effect of pain on fear. Conclusions These results support previous findings about the importance of fear and depression as factors that should be targeted in low back pain patients to reduce back pain related disability. We have also extended understanding for the mediating effect of catastrophizing on back pain related disability. Back pain patients engaged with regular physical activity may require counselling with regards to negative pain perceptions. PMID:28686644

High social anxiety and poor quality of life in patients with pulmonary tuberculosis.

PubMed

Kibrisli, Erkan; Bez, Yasin; Yilmaz, Ahmet; Aslanhan, Hamza; Taylan, Mahsuk; Kaya, Halide; Tanrikulu, Abdullah Cetin; Abakay, Ozlem

2015-01-01

Pulmonary tuberculosis (PT) has been previously related with various psychosocial adverse consequences including stigmatization and social isolation.Social anxiety is a psychiatric condition that may be associated with social isolation and fear of social exclusion.To date no study has investigated social anxiety and its impact on quality of life (QoL) among patients with PT. Therefore, we aimed to determine the severity of social anxiety in a group of patients with PT.Among patients who were recently discharged from hospital with the diagnosis of PT 94 patients and 99 healthy control subjects who had similar demographical features have been included in the study. A psychiatrist interviewed all participants and a semistructured interview form, which was prepared by the authors, Liebowitz Social Anxiety Scale (LSAS), and Short Form-36 were administered to them.Patients with PT showed higher levels of performance avoidance and social avoidance than healthy control subjects. They reported lower QoL scores across all dimensions. Among patients women showed higher levels of LSAS subscale scores and total score. Fear of social exclusion was predicted by perceived illness severity and emotional role difficulty. On the other hand, perceived illness severity was predicted by fear of exclusion and sedimentation level.PT patients seem to experience higher levels of social anxiety and associated fear of social exclusion that add to their worse QoL during the earlier months of their disease. Among them fear of social exclusion is related with perceived illness severity.

Men's hopes, fears and challenges in engagement in perinatal health and the prevention of mother-to-child transmission of HIV in rural Kenya.

PubMed

Musoke, Pamela; Hatcher, Abigail; Rogers, Anna Joy; Achiro, Lillian; Bukusi, Elizabeth; Darbes, Lynae; Kwena, Zachary; Oyaro, Patrick; Weke, Elly; Turan, Janet M

2018-02-21

Male involvement in antenatal care has been shown to improve health outcomes for women and infants. However, little is known about how best to encourage male partners to support essential perinatal health activities. We explored men's perceptions of facilitators and barriers to involvement in antenatal care and HIV prevention including fears, hopes and challenges. Forty in-depth interviews were conducted with the male partners of HIV-positive and HIV-negative pregnant women in southwest Kenya. Most male partners believed engaging in pregnancy health-related activities was beneficial for keeping families healthy. However, thematic analysis revealed several obstacles that hindered participation. Poor couple relationship dynamics seemed negatively to influence male engagement. Some men were apprehensive that clinic staff might force them to test for HIV and disclose the results; if HIV-positive, men feared being labelled as 'victimisers' in situations of serodiscordancy, and described fears of abandonment by their wives. Some men avoided accompanying their wives, citing local culture as rationale for avoiding the 'effeminate' act of antenatal care attendance. Amidst these obstacles, some men chose to use their partners' HIV status as proxy for their own. Findings suggest that improving male engagement in essential maternal and child health-related activities will require addressing both structural and interpersonal barriers.

Treatment of avoidance behavior as an adjunct to exposure therapy: Insights from modern learning theory.

PubMed

Treanor, Michael; Barry, Tom J

2017-09-01

Pathological avoidance of benign stimuli is a hallmark of anxiety and related disorders, and exposure-based treatments have often encouraged the removal of avoidance, or safety behaviors, due to their negative effects on extinction learning. Unfortunately, empirical evidence suggests that avoidance behaviors can persist following treatment, and the mere availability of avoidance behavior can be sufficient to renew fear following successful extinction learning. The present paper critically examines the function of avoidance behavior through the lens of modern learning theory, and speculates on novel behavioral and pharmacological strategies for targeting avoidance as an adjunct to current evidence-based treatments. Copyright © 2017. Published by Elsevier Ltd.

The experience of living with patellofemoral pain—loss, confusion and fear-avoidance: a UK qualitative study

PubMed Central

Moffatt, Fiona; Hendrick, Paul; Bateman, Marcus; Rathleff, Michael Skovdal; Selfe, James; Smith, Toby O; Logan, Pip

2018-01-01

Objectives To investigate the experience of living with patellofemoral pain (PFP). Design Qualitative study design using semistructured interviews and analysed thematically using the guidelines set out by Braun and Clarke. Setting A National Health Service physiotherapy clinic within a large UK teaching hospital. Participants A convenience sample of 10 participants, aged between 18 and 40 years, with a diagnosis of PFP and on a physiotherapy waiting list, prior to starting physiotherapy. Results Participants offered rich and detailed accounts of the impact and lived experience of PFP, including loss of physical and functional ability; loss of self-identity; pain-related confusion and difficulty making sense of their pain; pain-related fear, including fear-avoidance and ‘damage’ beliefs; inappropriate coping strategies and fear of the future. The five major themes that emerged from the data were: (1) impact on self; (2) uncertainty, confusion and sense making; (3) exercise and activity beliefs; (4) behavioural coping strategies and (5) expectations of the future. Conclusions These findings offer an insight into the lived experience of individuals with PFP. Previous literature has focused on pain and biomechanics, rather than the individual experience, attached meanings and any wider context within a sociocultural perspective. Our findings suggest that future research is warranted into biopsychosocial targeted interventions aimed at the beliefs and pain-related fear for people with PFP. The current consensus that best-evidence treatments consisting of hip and knee strengthening may not be adequate to address the fears and beliefs identified in the current study. Further qualitative research may be warranted on the impact and interpretation of medical terminology commonly used with this patient group, for example, ‘weakness’ and ‘patellar mal-tracking’ and its impact and interpretation by patients. Trial registration number ISRCTN35272486; Pre-results. PMID:29362256

Generalization of Social Anxiety to Sport: An Investigation of Elementary Aged Hispanic Children.

ERIC Educational Resources Information Center

Storch, Eric A.; Barlas, Mitchell E.; Dent, Heather C.; Masia, Carrie L.

2002-01-01

Used the Social Anxiety Scale for Children-Revised and additional questions to examine the relationship of social anxiety to sport anxiety and avoidance in a sample of urban Hispanic American fifth and sixth graders. Found that, for girls, fear of negative evaluation and social avoidance of general and new situations were associated with sport…

The Ivory Tower Meets the Inner City: Student Protective and Avoidance Behaviors on an Urban University Campus

ERIC Educational Resources Information Center

Hignite, Lance R.; Marshall, Shantal; Naumann, Laura

2018-01-01

Despite relatively low levels of crime on campus, college and university students are not immune from criminal victimization. Students' levels of fear of crime on campus, perceptions regarding the likelihood of victimization, and confidence in campus police, shape their decisions to engage in specific avoidance and protective behaviors. This study…

Math Avoidance: A Barrier to American Indian Science Education and Science Careers.

ERIC Educational Resources Information Center

Green, Rayna

1978-01-01

For American Indian students, math anxiety and math avoidance are the most serious obstacles to general education and to the choice of scientific careers. Indian students interviewed generally exhibited fear and loathing of mathematics and a major lack of basic skills which were caused by a missing or negative impression of the mathematics…

Attachment, self-esteem, worldviews, and terror management: evidence for a tripartite security system.

PubMed

Hart, Joshua; Shaver, Phillip R; Goldenberg, Jamie L

2005-06-01

On the basis of prior work integrating attachment theory and terror management theory, the authors propose a model of a tripartite security system consisting of dynamically interrelated attachment, self-esteem, and worldview processes. Four studies are presented that, combined with existing evidence, support the prediction derived from the model that threats to one component of the security system result in compensatory defensive activation of other components. Further, the authors predicted and found that individual differences in attachment style moderate the defenses. In Studies 1 and 2, attachment threats motivated worldview defense among anxiously attached participants and motivated self-enhancement (especially among avoidant participants), effects similar to those caused by mortality salience. In Studies 3 and 4, a worldview threat and a self-esteem threat caused attachment-related proximity seeking among fearful participants and avoidance of proximity among dismissing participants. The authors' model provides an overarching framework within which to study attachment, self-esteem, and worldviews.

AAFP and ISFM feline-friendly handling guidelines.

PubMed

Rodan, Ilona; Sundahl, Eliza; Carney, Hazel; Gagnon, Anne-Claire; Heath, Sarah; Landsberg, Gary; Seksel, Kersti; Yin, Sophia

2011-05-01

The number of pet cats is increasing in most countries, often outnumbering pet dogs, yet cats receive less veterinary care than their canine counterparts.(1) Clients state the difficulty of getting the cat into a carrier at home, driving to the clinic, and dealing with the fearful cat at the veterinary clinic as reasons for fewer visits.(2) Educating and preparing the client and the veterinary team with regard to respectful feline handling is necessary in order to avoid stress and accomplish the goal of good health care. Without such preparation, feline stress may escalate into fear or fear-associated aggression. The resulting stress may alter results of the physical examination and laboratory tests, leading to incorrect diagnoses (eg, diabetes mellitus) and unnecessary treatments.(3-5) Without compassionate and respectful handling by the veterinary team, clients may feel the team lacks skills and compassion, or does not understand cats. Injury may occur to the cat, client and/or veterinary team.(6) Clients who want to avoid stress for their cat may avoid veterinary visits or choose another practice instead. The use of feline-friendly handling techniques should reduce these problems. Handling is most successful when the veterinary team adapts the approach to each individual cat and situation. The goal of these guidelines is to provide useful information for handling cats that can lead to: ✜ Reduced fear and pain for the cat. ✜ Reinforced veterinarian-client-cat bond, trust and confidence, and thus better lifelong medical care for the cat. ✜ Improved efficiency, productivity and job satisfaction for the veterinary team. ✜ Increased client compliance. ✜ Timely reporting and early detection of medical and behavioral concerns. ✜ Fewer injuries to clients and the veterinary team. ✜ Reduced anxiety for the client. Copyright © 2011 Elsevier Inc. All rights reserved.

A prospective 2-year examination of cognitive and behavioral correlates of provoked vestibulodynia outcomes.

PubMed

Davis, Seth N P; Bergeron, Sophie; Bois, Katy; Sadikaj, Gentiana; Binik, Yitzchak M; Steben, Marc

2015-04-01

Provoked vestibulodynia (PVD) is a common genital pain disorder in women that is associated with sexual dysfunction and lowered sexual satisfaction. A potentially applicable cognitive-behavioral model of chronic pain and disability is the fear-avoidance model (FAM) of pain. The FAM posits that cognitive variables, such as pain catastrophizing, fear, and anxiety lead to avoidance of pain-provoking behaviors (eg, intercourse), resulting in continued pain and disability. Although some of the FAM variables have been shown to be associated with PVD pain and sexuality outcomes, the model as a whole has never been tested in this population. An additional protective factor, pain self-efficacy (SE), is also associated with PVD, but has not been tested within the FAM model. Using a 2-year longitudinal design, we examine (1) whether initial levels (T1) of the independent FAM variables and pain SE were associated with changes in pain, sexual function, and sexual satisfaction over the 2-year time period; (2) the prospective contribution of changes in cognitive-affective (FAM) variables to changes in pain, and sexuality outcomes; and (3) whether these were mediated by behavioral change (avoidance of intercourse). A sample of 222 women with PVD completed self-report measures of FAM variables, SE, pain, sexual function, and sexual satisfaction at time 1 and at a 2-year follow-up. Structural equation modeling with Latent Difference Scores was used to examine changes and to examine mediation between variables. Questionnaires included the Pain Catastrophizing Scale, McGill Pain Questionnaire, Trait Anxiety Inventory, Pain Self-Efficacy Scale, and Global Measure of Sexual Satisfaction, Female Sexual Function Index. Participants who reported higher SE at T1 reported greater declines in pain, greater increases in sexual satisfaction, and greater declines in sexual function over the 2 time points. The overall change model did not support the FAM using negative cognitive-affective variables. Only increases in pain SE were associated with reductions in pain intensity. The relationship between changes in SE and changes in pain was partially mediated through changes in avoidance (more intercourse attempts). The same pattern of results was found for changes in sexual satisfaction as the outcome, and a partial mediation effect was found. There were no significant predictors of changes in sexual function other than T1 SE. Changes in both cognitive and behavioral variables were significantly associated with improved pain and sexual satisfaction outcomes. However, it was the positive changes in SE that better predicted changes in avoidance behavior, pain, and sexual satisfaction. Cognitive-behavior therapy is often focused on changing negative pain-related cognitions to reduce avoidance and pain, but the present results demonstrate the potential importance of bolstering positive self-beliefs as well. Indeed, before engaging in exposure therapies, SE beliefs should be assessed and potentially targeted to improve adherence to exposure strategies.

Possible selves in patients with right- versus left-onset Parkinson's disease.

PubMed

Harris, Erica; McNamara, Patrick; Durso, Raymon

2017-03-01

Possible selves can be used to self-regulate and guide behavior towards what is desired to be achieved or avoided in life. Previous work suggests laterality effects exist within the brain regarding approach and avoidance systems to achieve self-regulation. A modified version of the possible selves task was administered to 45 patients with PD (22 right-onset and 23 left-onset) and 25 community dwelling control subjects (CS). Only 11.1% of patients exhibited balance among their hoped-for and feared possible selves versus 28% of CS. More right-onset patients used a promotion strategy whereas more left-onset patients used a prevention strategy. Patients with left-onset PD thought more about their feared selves, exhibiting reduced goal-directed behavior. Findings among the left-onset group indicate relative dependence of self-regulation on right-sided avoidance brain systems. This may point to an inability to move away from negative outcomes and to work towards rewarding outcomes, which could affect psychological health.

Threatening joy: approach and avoidance reactions to emotions are influenced by the group membership of the expresser.

PubMed

Paulus, Andrea; Wentura, Dirk

2014-01-01

It has been repeatedly stated that approach and avoidance reactions to emotional faces are triggered by the intention signalled by the emotion. This line of thought suggests that each emotion signals a specific intention triggering a specific behavioural reaction. However, empirical results examining this assumption are inconsistent, suggesting that it might be too short-sighted. We hypothesise that the same emotional expression can signal different social messages and, therefore, trigger different reactions; which social message is signalled by an emotional expression should be influenced by moderating variables, such as the group membership of the expresser. In two experiments, we show that group membership influences approach and avoidance reactions to emotional expressions: Emotions (fear and happiness) expressed by in-group members elicited concordant behaviour, whereas emotions expressed by out-group members activated the reverse pattern. A third experiment, in which participants directly evaluated smiling and fearful individuals resembling in-group and out-group members supported this result.

Virtual Reality Therapy: case study of fear of public speaking.

PubMed

North, Max M; Schoeneman, Curt M; Mathis, James R

2002-01-01

The major goal of this research case study was to investigate the effectiveness of Virtual Reality Therapy (VRT) in the treatment of the fear of public speaking. A twenty-eight-year-old Caucasian male was selected from questionnaires distributed to a class of undergraduate students enrolled at Kennesaw State University. Two assessment measures were used in this study. The first measure used was the Attitude Towards Public Speaking (ATPS) Questionnaire. The second measure used was the eleven-point Subjective Units of Disturbance (SUD) scale. These measurements assessed the anxiety, avoidance, attitudes and disturbance associated with the subject's fear of public speaking before and after each VRT treatment session. This case study of public speaking fear indicates that VRT may be used as an effective treatment method for reducing self-reported anxiety.

Symptom presentation and classroom functioning in a nonclinical sample of children with social phobia.

PubMed

Bernstein, Gail A; Bernat, Debra H; Davis, Andrew A; Layne, Ann E

2008-01-01

This study investigates symptom presentation and school functioning in a nonclinical sample of children with social phobia (SP). Forty-five children with SP were identified via school-wide screenings and follow-up diagnostic interviews. Analyses examined types and intensity of fears, number of social situations avoided, interpersonal relationships, and classroom functioning. To identify characteristics unique to social phobic children, children with SP (n = 45) were compared to anxious children without SP (n = 56) on the above variables. Comorbidity in children with SP and factors associated with SP severity were also evaluated. Compared to anxious children without SP, children with SP feared and avoided a significantly greater number of social situations. In addition, they were significantly more likely to have trouble with making friends and to prefer being alone rather than with peers. All children with SP met criteria for at least one comorbid disorder. Significant factors explaining child-reported severity of SP were number of social situations avoided and intensity of fears. Greater severity of SP was significantly associated with poorer social skills, poorer leadership skills, greater attention difficulties, and greater learning problems in the classroom. It is important to understand the symptom presentation of SP so that children with SP are identified early and effective interventions are instituted. This is especially critical given the impact of SP on school functioning. Published 2007 Wiley-Liss, Inc.

The Role Of Basal Forebrain Cholinergic Neurons In Fear and Extinction Memory

PubMed Central

Knox, Dayan

2016-01-01

Cholinergic input to the neocortex, dorsal hippocampus (dHipp), and basolateral amygdala (BLA) is critical for neural function and synaptic plasticity in these brain regions. Synaptic plasticity in the neocortex, dHipp, ventral Hipp (vHipp), and BLA has also been implicated in fear and extinction memory. This finding raises the possibility that basal forebrain (BF) cholinergic neurons, the predominant source of acetylcholine in these brain regions, have an important role in mediating fear and extinction memory. While empirical studies support this hypothesis, there are interesting inconsistencies among these studies that raise questions about how best to define the role of BF cholinergic neurons in fear and extinction memory. Nucleus basalis magnocellularis (NBM) cholinergic neurons that project to the BLA are critical for fear memory and contextual fear extinction memory. NBM cholinergic neurons that project to the neocortex are critical for cued and contextual fear conditioned suppression, but are not critical for fear memory in other behavioral paradigms and in the inhibitory avoidance paradigm may even inhibit contextual fear memory formation. Medial septum and diagonal band of Broca cholinergic neurons are critical for contextual fear memory and acquisition of cued fear extinction. Thus, even though the results of previous studies suggest BF cholinergic neurons modulate fear and extinction memory, inconsistent findings among these studies necessitates more research to better define the neural circuits and molecular processes through which BF cholinergic neurons modulate fear and extinction memory. Furthermore, studies determining if BF cholinergic neurons can be manipulated in such a manner so as to treat excessive fear in anxiety disorders are needed. PMID:27264248

Less is More: Neural Activity During Very Brief and Clearly Visible Exposure to Phobic Stimuli

PubMed Central

Siegel, Paul; Warren, Richard; Wang, Zhishun; Yang, Jie; Cohen, Don; Anderson, Jason F.; Murray, Lilly; Peterson, Bradley S.

2017-01-01

Research on automatic processes in emotion has focused almost exclusively on the provocation of fear responses. We have shown, in contrast, that the repeated presentation of masked feared images reduces avoidance of a live tarantula by spider-phobic participants. We investigated the neural basis for these adaptive effects of masked exposure. We identified 21 spider-phobic and 21 control participants using a psychiatric interview, fear questionnaire, and approach behavior towards a live tarantula. They received each of three conditions: (1) very brief exposure (VBE) to masked images of spiders; (2) clearly visible exposure (CVE) to spiders; and (3) masked images of flowers (control). Only VBE to masked spiders generated neural activity more strongly in phobic than in control participants, within subcortical fear, attention, higher-order language, and vision systems. Counter-intuitively, CVE to the same spiders generated stronger neural activity in control rather than phobic participants within these and other systems. VBE activated regions that support fear processing in phobic participants without causing them to experience fear consciously. CVE, by contrast, deactivated regions supporting fear regulation and caused phobic participants to experience fear. Activations by CVE to spiders correlated with fear ratings - explicit fear. Activations by VBE to masked spiders correlated with color-naming interference of spider words – implicit fear. These multiple dissociations between the effects of VBE and CVE to spiders suggest that limiting awareness of exposure to phobic stimuli through visual masking paradoxically facilitates their processing, while simultaneously minimizing the experience of fear. PMID:28165171

Social anxiety disorder

MedlinePlus

Phobia - social; Anxiety disorder - social; Social phobia; SAD - social anxiety disorder ... People with social anxiety disorder fear and avoid situations in which they may be judged by others. It may begin in ...

Biologically inspired robots elicit a robust fear response in zebrafish

NASA Astrophysics Data System (ADS)

Ladu, Fabrizio; Bartolini, Tiziana; Panitz, Sarah G.; Butail, Sachit; Macrı, Simone; Porfiri, Maurizio

2015-03-01

We investigate the behavioral response of zebrafish to three fear-evoking stimuli. In a binary choice test, zebrafish are exposed to a live allopatric predator, a biologically-inspired robot, and a computer-animated image of the live predator. A target tracking algorithm is developed to score zebrafish behavior. Unlike computer-animated images, the robotic and live predator elicit a robust avoidance response. Importantly, the robotic stimulus elicits more consistent inter-individual responses than the live predator. Results from this effort are expected to aid in hypothesis-driven studies on zebrafish fear response, by offering a valuable approach to maximize data-throughput and minimize animal subjects.

It depends: Approach and avoidance reactions to emotional expressions are influenced by the contrast emotions presented in the task.

PubMed

Paulus, Andrea; Wentura, Dirk

2016-02-01

Studies examining approach and avoidance reactions to emotional expressions have yielded conflicting results. For example, expressions of anger have been reported to elicit approach reactions in some studies but avoidance reactions in others. Nonetheless, the results were often explained by the same general underlying process, namely the influence that the social message signaled by the expression has on motivational responses. It is therefore unclear which reaction is triggered by which emotional expression, and which underlying process is responsible for these reactions. In order to address this issue, we examined the role of a potential moderator on approach and avoidance reactions to emotional expressions, namely the contrast emotion used in the task. We believe that different approach and avoidance reactions occur depending on the congruency or incongruency of the evaluation of the 2 emotions presented in the task. The results from a series of experiments supported these assumptions: Negative emotional expressions (anger, fear, sadness) elicited avoidance reactions if contrasted with expressions of happiness. However, if contrasted with a different negative emotional expression, anger and sadness triggered approach reactions and fear activated avoidance reactions. Importantly, these results also emerged if the emotional expression was not task-relevant. We propose that approach and avoidance reactions to emotional expressions are triggered by their evaluation if the 2 emotions presented in a task differ in evaluative connotation. If they have the same evaluative connotation, however, reactions are determined by their social message. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Threat and efficacy uncertainty in news coverage about bed bugs as unique predictors of information seeking and avoidance: an extension of the EPPM.

PubMed

Goodall, Catherine E; Reed, Phillip

2013-01-01

An experiment was conducted from the perspective of the Extended Parallel Process Model (EPPM) investigating readers' responses to print news stories about the issue of bed bugs. Stories containing reference to (a) the threat of bed bugs and (b) efficacy of the solution were manipulated to vary the level of certainty with which the variables were discussed. Results suggest that stories referencing uncertainty regarding presence of the bed-bug threat may be more likely to motivate intention to seek information than stories referencing certainty of the threat. Results also suggest that stories referencing uncertainty regarding feasibility/effectiveness of proposed solutions may be more likely to motivate intention to avoid information than stories referencing certainty of proposed solutions. Given that information avoidance is one of various types of maladaptive responses to fear appeal messages (according to EPPM), results suggest that the presence of uncertainty when discussing solutions to threats in news stories might result in problematic avoidance responses that discourage people from taking protective action.

Graded Exposure for Chronic Low Back Pain in Older Adults: A Pilot Study.

PubMed

Leonhardt, Corinna; Kuss, Katrin; Becker, Annette; Basler, Heinz-Dieter; de Jong, Jeroen; Flatau, Brigitta; Laekeman, Marjan; Mattenklodt, Peter; Schuler, Matthias; Vlaeyen, Johan; Quint, Sabine

Fear-avoidance beliefs in older adults with chronic low back pain (CLBP) can lead to disability. Graded exposure-based active physical therapy could be an option to enhance physical ability in older patients with CLBP. The purpose of this study was to develop a standardized graded exposure treatment according to the fear-avoidance model of musculoskeletal pain for older patients with CLBP and to examine its effectiveness and feasibility in the German health care system. The study represents a phase I/phase II trial of a complex intervention. Taking a first step into the hierarchy of growing empirical evidence, a prospective 1-factor observational study was conducted with repeated measurements 1 week before and within 2 weeks after the intervention. Three physical therapists, who completed an introductory workshop, provided the treatment in the form of individual therapies. Sixteen participants 65 years or older with CLBP and perceived physical limitations were recruited. Four patient-reported outcome measures and semistructured interviews were conducted. The primary outcome was physical ability measured with the Hanover Functional Ability Questionnaire. Secondary outcomes were the numerical pain rating scale, and an age-specific and adapted 11-item short-form of the Patient Anxiety Symptom Scale, the KVS-D 65+, which quantified catastrophizing and avoidance beliefs. Fear of falling was measured with the Falls Efficacy Scale-International. For the analysis, Wilcoxon signed-rank test for paired samples and an α level of .05 were chosen. For the qualitative evaluation, semistructured interviews were conducted with the patients and physical therapists explored indicators of feasibility such as demands, acceptability, satisfaction, adaptation needs, and implementation. For content analysis, codes were primarily derived deductively and complemented by inductively derived new themes. A significant increase in physical ability after the treatment was observed with an effect size (ES) of 0.95 (P = .008). With regard to secondary outcomes, there was a statistically significant decrease in pain intensity (P = .029) and a reduction in catastrophizing (ES = 0.91; P = .021) and avoidance beliefs (ES = 1.37; P = .001). The interviews revealed good acceptance and satisfaction of the treatment by the patients and physical therapists. On the whole, the treatment appears effective and feasible. Apart from the benefits achieved by the participants, the study provides a basis for designing future studies at a higher level of evidence.

Making Death, Compassion and Partnership "Part of Life" in School Communities

ERIC Educational Resources Information Center

Kennedy, Carla Jane; Keeffe, Mary; Gardner, Fiona; Farrelly, Cathleen

2017-01-01

Death can be considered a social taboo, a common source of fear and public avoidance. School communities are not immune to this, as the topic of death is constantly avoided. It is vital to understand how we can socially and culturally cultivate a positive regard for death, dying and bereavement in our school communities. Community members need to…

Reconceptualizing emetophobia: a cognitive-behavioral formulation and research agenda.

PubMed

Boschen, Mark J

2007-01-01

Fear of vomiting (emetophobia) is a poorly understood anxiety disorder, with little research published into its conceptualization or treatment. The current article uses established cognitive and behavioral models of other anxiety disorders as a basis from which to propose a detailed model of emetophobia. The model proposes that emetophobia results from a constellation of factors including a general anxiety-vulnerability factor, a tendency to somatize anxiety as gastrointestinal distress, a tendency to catastrophically misappraise nausea and other gastrointestinal symptoms, hypervigilance to gastrointestinal cues, beliefs about the unacceptability of vomiting, negatively reinforced avoidance behavior, and selective confirmation biases. A formulation-based treatment package for emetophobia is outlined, including arousal management skills, distraction/attention training, exposure and cognitive restructuring.

Cat odor causes long-lasting contextual fear conditioning and increased pituitary-adrenal activation, without modifying anxiety.

PubMed

Muñoz-Abellán, Cristina; Daviu, Nuria; Rabasa, Cristina; Nadal, Roser; Armario, Antonio

2009-10-01

A single exposure to a cat or cat odors has been reported by some groups to induce contextual and auditory fear conditioning and long-lasting changes in anxiety-like behaviour, but there is no evidence for parallel changes in biological stress markers. In the present study we demonstrated in male rats that exposure to a novel environment containing a cloth impregnated with cat fur odor resulted in avoidance of the odor, lower levels of activity and higher pituitary-adrenal (PA) response as compared to those exposed to the novel environment containing a clean cloth, suggesting increased levels of stress in the former animals. When re-exposed 9 days later to the same environment with a clean cloth, previously cat fur exposed rats again showed avoidance of the cloth area and lower levels of activity, suggesting development of contextual fear conditioning, which again was associated with a higher PA activation. In contrast, unaltered both anxiety-like behaviour and PA responsiveness to an elevated plus-maze were found 7 days after cat odor exposure. It is concluded that: (i) PA activation is able to reflect both the stressful properties of cat fur odor and odor-induced contextual fear conditioning; (ii) development of cat odor-induced contextual fear conditioning is independent of the induction of long-lasting changes in anxiety-like behaviour; and (iii) greater PA activation during exposure to the odor context is not explained by non-specific sensitization of the PA axis caused by previous exposure to cat fur odor.

Task-related and person-related variables influence the effect of low back pain on anticipatory postural adjustments.

PubMed

Jacobs, Jesse V; Lyman, Courtney A; Hitt, Juvena R; Henry, Sharon M

2017-08-01

People with low back pain exhibit altered postural coordination that has been suggested as a target for treatment, but heterogeneous presentation has rendered it difficult to identify appropriate candidates and protocols for such treatments. This study evaluated the associations of task-related and person-related factors with the effect of low back pain on anticipatory postural adjustments. Thirteen subjects with and 13 without low back pain performed seated, rapid arm flexion in self-initiated and cued conditions. Mixed-model ANOVA were used to evaluate group and condition effects on APA onset latencies of trunk muscles, arm-raise velocity, and pre-movement cortical potentials. These measures were evaluated for correlation with pain ratings, Fear Avoidance Beliefs Questionnaire scores, and Modified Oswestry Questionnaire scores. Delayed postural adjustments of subjects with low back pain were greater in the cued condition than in the self-initiated condition. The group with low back pain exhibited larger-amplitude cortical potentials than the group without pain, but also significantly slower arm-raise velocities. With arm-raise velocity as a covariate, the effect of low back pain remained significant for the latencies of postural adjustments but not for cortical potentials. Latencies of the postural adjustments significantly correlated with Oswestry and Fear Avoidance Beliefs scores. Delayed postural adjustments with low back pain appear to be influenced by cueing of movement, pain-related disability and fear of activity. These results highlight the importance of subject characteristics, task condition, and task performance when comparing across studies or when developing treatment of people with low back pain. Copyright © 2017 Elsevier B.V. All rights reserved.

Tick Removal

MedlinePlus

... down the toilet. Avoid folklore remedies such as “painting” the tick with nail polish or petroleum jelly, ... Privacy FOIA No Fear Act OIG 1600 Clifton Road Atlanta , GA 30329-4027 USA 800-CDC-INFO ( ...

Innate Predator Odor Aversion Driven by Parallel Olfactory Subsystems that Converge in the Ventromedial Hypothalamus

PubMed Central

Pérez-Gómez, Anabel; Bleymehl, Katherin; Stein, Benjamin; Pyrski, Martina; Birnbaumer, Lutz; Munger, Steven D.; Leinders-Zufall, Trese; Zufall, Frank; Chamero, Pablo

2015-01-01

Summary The existence of innate predator aversion evoked by predator-derived chemostimuli called kairomones offers a strong selective advantage for potential prey animals. However, it is unclear how chemically-diverse kairomones can elicit similar avoidance behaviors. Using a combination of behavioral analyses and single-cell Ca2+ imaging in wild-type and gene-targeted mice, we show that innate predator-evoked avoidance is driven by parallel, non-redundant processing of volatile and nonvolatile kairomones through the activation of multiple olfactory subsystems including the Grueneberg ganglion, the vomeronasal organ, and chemosensory neurons within the main olfactory epithelium. Perturbation of chemosensory responses in specific subsystems through disruption of genes encoding key sensory transduction proteins (Cnga3, Gnao1) or by surgical axotomy abolished avoidance behaviors and/or cellular Ca2+ responses to different predator odors. Stimulation of these different subsystems resulted in the activation of widely distributed target regions in the olfactory bulb, as assessed by c-Fos expression. However, in each case this c-Fos increase was observed within the same subnuclei of the medial amygdala and ventromedial hypothalamus, regions implicated in fear, anxiety and defensive behaviors. Thus, the mammalian olfactory system has evolved multiple, parallel mechanisms for kairomone detection that converge in the brain to facilitate a common behavioral response. Our findings provide significant insights into the genetic substrates and circuit logic of predator-driven, innate aversion and may serve as a valuable model for studying instinctive fear [1] and human emotional and panic disorders [2, 3]. PMID:25936549

Innate Predator Odor Aversion Driven by Parallel Olfactory Subsystems that Converge in the Ventromedial Hypothalamus.

PubMed

Pérez-Gómez, Anabel; Bleymehl, Katherin; Stein, Benjamin; Pyrski, Martina; Birnbaumer, Lutz; Munger, Steven D; Leinders-Zufall, Trese; Zufall, Frank; Chamero, Pablo

2015-05-18

The existence of innate predator aversion evoked by predator-derived chemostimuli called kairomones offers a strong selective advantage for potential prey animals. However, it is unclear how chemically diverse kairomones can elicit similar avoidance behaviors. Using a combination of behavioral analyses and single-cell Ca(2+) imaging in wild-type and gene-targeted mice, we show that innate predator-evoked avoidance is driven by parallel, non-redundant processing of volatile and nonvolatile kairomones through the activation of multiple olfactory subsystems including the Grueneberg ganglion, the vomeronasal organ, and chemosensory neurons within the main olfactory epithelium. Perturbation of chemosensory responses in specific subsystems through disruption of genes encoding key sensory transduction proteins (Cnga3, Gnao1) or by surgical axotomy abolished avoidance behaviors and/or cellular Ca(2+) responses to different predator odors. Stimulation of these different subsystems resulted in the activation of widely distributed target regions in the olfactory bulb, as assessed by c-Fos expression. However, in each case, this c-Fos increase was observed within the same subnuclei of the medial amygdala and ventromedial hypothalamus, regions implicated in fear, anxiety, and defensive behaviors. Thus, the mammalian olfactory system has evolved multiple, parallel mechanisms for kairomone detection that converge in the brain to facilitate a common behavioral response. Our findings provide significant insights into the genetic substrates and circuit logic of predator-driven innate aversion and may serve as a valuable model for studying instinctive fear and human emotional and panic disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.

Hippocampal Mek/Erk signaling mediates extinction of contextual freezing behavior.

PubMed

Fischer, Andre; Radulovic, Marko; Schrick, Christina; Sananbenesi, Farahnaz; Godovac-Zimmermann, Jasminka; Radulovic, Jelena

2007-01-01

Fear memories elicit multiple behavioral responses, encompassing avoidance, or behavioral inhibition in response to threatening contexts. Context-specific freezing, reflecting fear-induced behavioral inhibition, has been proposed as one of the main risks factors for the development of anxiety disorders. We attempted to define the key hippocampal mediators of extinction in a mouse model of context-dependent freezing. Nine-week-old male C57BL/6J mice were trained and tested for contextual fear conditioning and extinction. Freezing behavior scored by unbiased sampling, was used as an index of fear. Proteomic, immunoblot, and immunohistochemical approaches were employed to identify, verify, and analyze the alterations of the hippocampal extracellular signal-regulated kinases 1 and 2 (Erk-1/2). Targeted pharmacological inhibition of the Erk-1/2 activating kinase, the mitogen activated and extracellular signal-regulated kinase (Mek), served to establish the role of Mek/Erk signaling in extinction. When compared to acquisition, extinction of contextual freezing triggered a rapid activation of Erk-1/2 showing a distinctive time-course, nuclear localization, and subcellular isoform distribution. These differences suggested that the upstream regulation and downstream effects of this pathway might be specific for each process. Dorsohippocampal injections of the Mek inhibitors U0126 (0.5 microg/site) and PD98059 (1.5 microg/site) immediately after the nonreinforced trials prevented Erk-1/2 activation and significantly impaired extinction. This effect was dissociable from potential actions on memory retrieval or reconsolidation. On the basis of these findings, we propose that hippocampal Mek/Erk signaling might serve as one of the key mediators of contextual fear extinction.

A two-dimensional neuropsychology of defense: fear/anxiety and defensive distance.

PubMed

McNaughton, Neil; Corr, Philip J

2004-05-01

We present in this paper a picture of the neural systems controlling defense that updates and simplifies Gray's "Neuropsychology of Anxiety". It is based on two behavioural dimensions: 'defensive distance' as defined by the Blanchards and 'defensive direction'. Defensive direction is a categorical dimension with avoidance of threat corresponding to fear and approach to threat corresponding to anxiety. These two psychological dimensions are mapped to underlying neural dimensions. Defensive distance is mapped to neural level, with the shortest defensive distances involving the lowest neural level (periaqueductal grey) and the largest defensive distances the highest neural level (prefrontal cortex). Defensive direction is mapped to separate parallel streams that run across these levels. A significant departure from prior models is the proposal that both fear and anxiety are represented at all levels. The theory is presented in a simplified form that does not incorporate the interactions that must occur between non-adjacent levels of the system. It also requires expansion to include the dimension of escapability of threat. Our current development and these proposed future extensions do not change the core concepts originally proposed by Gray and, we argue, demonstrate their enduring value.

Attentional focus during exposure in spider phobia: The effect of valence and schematicity of a partial distractor.

PubMed

Dethier, Vincent; Philippot, Pierre

2017-06-01

This study examines the impact of partial distractor valence and schematicity (i.e., their relation to fear representation) on exposure efficacy. One hundred forty-one spider phobics were exposed to spider pictures and asked, in a between-subjects experimental design, to form mental images of words that were fear related (to spiders) and negative (schematic negative), fear unrelated and negative (non-schematic negative) or fear unrelated and positive (non-schematic positive). Multilevel measures of anxiety were performed at pre-exposure, post-exposure and 6 days' follow-up. Results show that both of the negative condition groups displayed similar results on all outcome variables and systematically differed from the positive condition group. While the latter group displayed a stronger decline in distress during exposure itself, the other groups showed greater exposure benefits: a stronger decline in emotional and avoidance responses and skin conductance responses from pre- to post-exposure and more approach behaviours when confronted with a real spider. The critical feature of distraction thus seems not to be the fact of being distracted from the phobic stimulus, but rather the fact of performing emotional avoidance by distracting oneself from negative affect. The results highlight that the acceptance of aversive emotional states is a critical active process in successful exposure. Copyright © 2017 Elsevier Ltd. All rights reserved.

Predictors of task-persistent and fear-avoiding behaviors in women with sexual pain disorders.

PubMed

Brauer, Marieke; Lakeman, Mariëlle; van Lunsen, Rik; Laan, Ellen

2014-12-01

Dyspareunia and vaginismus are the most common sexual pain disorders (SPDs). Literature suggests that many women with dyspareunia continue with intercourse despite pain (task persistence), whereas many women with vaginismus avoid penetrative activities that may cause pain (fear avoidance). Both forms of sexual pain behavior may maintain or aggravate complaints. This study examined (i) whether women with SPD differ from pain-free controls in motives for sexual intercourse, sexual autonomy, maladaptive beliefs regarding vaginal penetration, and partner responses to pain; and (ii) which of these factors best predict whether women with SPD stop or continue painful intercourse (attempts). Women with superficial dyspareunia (n = 50), women with lifelong vaginismus (n = 20), and pain-free controls (n = 45) completed questionnaires. For Aim 1, the main outcome measures were (i) motives for intercourse; (ii) sexual autonomy; (iii) maladaptive beliefs regarding vaginal penetration; and (iv) partner responses to pain. For Aim 2, sexual pain behavior (to continue or discontinue with painful intercourse) was the outcome measure. (i) Women with dyspareunia exhibited more mate guarding and duty/pressure motives for intercourse and were less sexually autonomous than controls. (ii) Symptomatic women had more maladaptive penetration-related beliefs than controls, with women with vaginismus reporting the strongest maladaptive beliefs. (iii) Partners of women with dyspareunia self-reported more negative responses to pain than those of women with vaginismus. (iv) The factors that best predicted sexual pain behavior were the partner responses to pain and the woman's maladaptive beliefs regarding vaginal penetration. Our findings reveal support for task persistence in women with dyspareunia and fear avoidance in women with lifelong vaginismus. As such, it is important to consider these distinct types of responding to sexual pain when treating SPD. © 2014 International Society for Sexual Medicine.

Computerized Dental Injection Fear Treatment

PubMed Central

Heaton, L.J.; Leroux, B.G.; Ruff, P.A.; Coldwell, S.E.

2013-01-01

One in four adults reports a clinically significant fear of dental injections, leading many to avoid dental care. While systematic desensitization is the most common therapeutic method for treating specific phobias such as fear of dental injections, lack of access to trained therapists, as well as dentists’ lack of training and time in providing such a therapy, means that most fearful individuals are not able to receive the therapy needed to be able to receive necessary dental treatment. Computer Assisted Relaxation Learning (CARL) is a self-paced computerized treatment based on systematic desensitization for dental injection fear. This multicenter, block-randomized, dentist-blind, parallel-group study conducted in 8 sites in the United States compared CARL with an informational pamphlet in reducing fear of dental injections. Participants completing CARL reported significantly greater reduction in self-reported general and injection-specific dental anxiety measures compared with control individuals (p < .001). Twice as many CARL participants (35.3%) as controls (17.6%) opted to receive a dental injection after the intervention, although this was not statistically significant. CARL, therefore, led to significant changes in self-reported fear in study participants, but no significant differences in the proportion of participants having a dental injection (ClinicalTrials.gov, NCT00609648). PMID:23690352

Perceptions of balance and falls following a supervised training intervention - a qualitative study of people with Parkinson's disease.

PubMed

Leavy, Breiffni; Berntsson, Johan; Franzén, Erika; Skavberg Roaldsen, Kirsti

2017-12-21

To explore perceptions of balance and falls among people with mild to moderate Parkinson's disease 3 - 12 months following participation in supervised balance training. This qualitative study used in-depth individual interviews for data collection among 13 people with Parkinson's disease. Interviews were systematically analyzed using qualitative content analysis with an inductive approach. Three main themes arose: Falls - avoided and intended highlights the wide spectrum of fall perceptions, ranging from worse-case scenario to undramatized events; Balance identity incorporates how gradual deterioration in balance served as a reminder of disease progression and how identifying themselves as "aware not afraid" helped certain participants to maintain balance confidence despite everyday activity restriction; Training as treatment recounts how participants used exercise as disease self-management with the aim to maintain independence in daily life. Interpretation of the underlying patterns of these main themes resulted in the overarching theme Training as treatment when battling problems with balance and falls. Whereas certain participants expressed a fear of falling which they managed by activity restriction, others described being confident in their balance despite avoidance of balance-challenging activities. Training was used as treatment to self-manage disease-related balance impairments in order to maintain independence in daily life. Implication for Rehabilitation People with Parkinson's disease require early advice about the positive effects of physical activity as well as strategies for self-management in order to ease the psychological and physical burden of progressive balance impairment. Fear of falling should be investigated alongside activity avoidance in this group in order to provide a more accurate insight into the scope of psychological concerns regarding balance and falls in everyday life. Certain people with Parkinson's disease define their balance according to activities they continue to participate in, while others who express fear-related activity avoidance require help to adapt balance-challenging activities in order to maintain balance confidence and avoid physical inactivity.

Rearing Laying Hens in Aviaries Reduces Fearfulness following Transfer to Furnished Cages

PubMed Central

Brantsæter, Margrethe; Tahamtani, Fernanda M.; Moe, Randi O.; Hansen, Tone B.; Orritt, Rachel; Nicol, Christine; Janczak, Andrew M.

2016-01-01

Appropriate rearing is essential for ensuring the welfare and productivity of laying hens. Early experience has the potential to affect the development of fearfulness. This study tested whether rearing in aviaries, as opposed to cages, reduces the fearfulness of laying hens after transfer to furnished cages. Fear responses were recorded as avoidance of a novel object in the home cage. Lohmann Selected Leghorns were reared in an aviary system or conventional rearing cages and then transported to furnished cages at 16 weeks, before the onset of lay. Observations of a selection of birds were conducted at 19 (N = 50 independent cages) and 21 (N = 48 independent cages) weeks of age. At 19 and 21 weeks, cage-reared birds showed higher levels of fearfulness indicated by spending more time away from the novel object compared to aviary-reared birds. These results suggest that rearing in an enriched aviary environment reduces fearfulness up to the fifth week after transfer to a new housing system, compared to rearing in cages. PMID:26955634

Emotional perception in eating disorders.

PubMed

Joos, Andreas A B; Cabrillac, Emmanuelle; Hartmann, Armin; Wirsching, Michael; Zeeck, Almut

2009-05-01

It remains an open question whether there are basic emotional perception and emotional processing deficits in eating disorders (ED). The aim of this study was to explore deficits in emotional perception in restrictive anorexia nervosa (AN-R) and bulimia nervosa (BN), using visual emotional stimuli. Thirty-four patients with ED (19 with BN and 15 with AN-R) were compared with 25 controls. Visual stimuli from the international affective picture system were used. Patients with AN-R showed increased fear when confronted with stimuli containing anger, whereas patients with BN showed a tendency towards decreased fear. There were no other fundamental differences in the emotional perception of fear, happiness, sadness, and anger. The finding of increased fear when exposed to the emotion of anger might be attributed to introversion and conflict avoidance of anorectic patients. No other basic deficiency of emotional perception was found.

Does the trait anxiety affect the dental fear?

PubMed

Doganer, Yusuf Cetin; Aydogan, Umit; Yesil, Hande Ucler; Rohrer, James Edwin; Williams, Mark Douglas; Agerter, David Charles

2017-05-04

The aims of the present study were to evaluate possible associations between trait anxiety, dental fear and the predictors of these interactions including demographic characteristics and dental history of patients applied to the dental care center in Ankara, Turkey. A sample of 607 participants (mean age: 21.02 ± 2.32) responded to a Turkish version of the Modified Dental Fear Survey (MDFS), the State-Trait Anxiety Inventory (STAI-T) and a questionnaire regarding previous negative dental experience. Multiple logistic regression analysis was used to identify the association between dental fear and the independent variables including trait anxiety, age groups, education level, dental visit frequency, experience and the source of dental knowledge. There was a trend for increasing in trait anxiety scores with greater levels of dental fear in a medium level of the dental fear group (OR = 1.055, 95%CI [1.025-1.086]; p < 0.001) and in a high level of the dental fear group (OR = 1.090 [1.057-1.124]; p < 0.001). Comparing to the low level of dental fear group; participants of medium dental fear level intended more likely to go to the dentist when they have a complaint instead of regularly going (odds ratio; OR = 3.177, 95%CI [1.304-7.741]; p = 0.011). Participants of high dental fear level tended to be less likely to have experienced no problem (OR = 0.476, 95%CI [0.284-0.795]; p = 0.005) than the low level of the dental fear group. We strongly indicate that higher dental fear scores have a predisposition of having high trait anxiety scores. Unpleasant dental experiences increased the risk for high dental fear levels. Patients with dental fear tended only to visit a dentist when necessary, avoiding regular visits.

The role of basal forebrain cholinergic neurons in fear and extinction memory.

PubMed

Knox, Dayan

2016-09-01

Cholinergic input to the neocortex, dorsal hippocampus (dHipp), and basolateral amygdala (BLA) is critical for neural function and synaptic plasticity in these brain regions. Synaptic plasticity in the neocortex, dHipp, ventral Hipp (vHipp), and BLA has also been implicated in fear and extinction memory. This finding raises the possibility that basal forebrain (BF) cholinergic neurons, the predominant source of acetylcholine in these brain regions, have an important role in mediating fear and extinction memory. While empirical studies support this hypothesis, there are interesting inconsistencies among these studies that raise questions about how best to define the role of BF cholinergic neurons in fear and extinction memory. Nucleus basalis magnocellularis (NBM) cholinergic neurons that project to the BLA are critical for fear memory and contextual fear extinction memory. NBM cholinergic neurons that project to the neocortex are critical for cued and contextual fear conditioned suppression, but are not critical for fear memory in other behavioral paradigms and in the inhibitory avoidance paradigm may even inhibit contextual fear memory formation. Medial septum and diagonal band of Broca cholinergic neurons are critical for contextual fear memory and acquisition of cued fear extinction. Thus, even though the results of previous studies suggest BF cholinergic neurons modulate fear and extinction memory, inconsistent findings among these studies necessitates more research to better define the neural circuits and molecular processes through which BF cholinergic neurons modulate fear and extinction memory. Furthermore, studies determining if BF cholinergic neurons can be manipulated in such a manner so as to treat excessive fear in anxiety disorders are needed. Copyright © 2016 Elsevier Inc. All rights reserved.

Individual Differences in Discriminatory Fear Learning under Conditions of Ambiguity: A Vulnerability Factor for Anxiety Disorders?

PubMed Central

Arnaudova, Inna; Krypotos, Angelos-Miltiadis; Effting, Marieke; Boddez, Yannick; Kindt, Merel; Beckers, Tom

2013-01-01

Complex fear learning procedures might be better suited than the common differential fear-conditioning paradigm for detecting individual differences related to vulnerability for anxiety disorders. Two such procedures are the blocking procedure and the protection-from-overshadowing procedure. Their comparison allows for the examination of discriminatory fear learning under conditions of ambiguity. The present study examined the role of individual differences in such discriminatory fear learning. We hypothesized that heightened trait anxiety would be related to a deficit in discriminatory fear learning. Participants gave US-expectancy ratings as an index for the threat value of individual CSs following blocking and protection-from-overshadowing training. The difference in threat value at test between the protected-from-overshadowing conditioned stimulus (CS) and the blocked CS was negatively correlated with scores on a self-report tension-stress scale that approximates facets of generalized anxiety disorder (GAD), the Depression Anxiety Stress Scale-Stress (DASS-S), but not with other individual difference variables. In addition, a behavioral test showed that only participants scoring high on the DASS-S avoided the protected-from-overshadowing CS. This observed deficit in discriminatory fear learning for participants with high levels of tension-stress might be an underlying mechanism for fear overgeneralization in diffuse anxiety disorders such as GAD. PMID:23755030

Cognitive and neural correlates of depression-like behaviour in socially defeated mice: an animal model of depression with cognitive dysfunction.

PubMed

Yu, Tao; Guo, Ming; Garza, Jacob; Rendon, Samantha; Sun, Xue-Li; Zhang, Wei; Lu, Xin-Yun

2011-04-01

Human depression is associated with cognitive deficits. It is critical to have valid animal models in order to investigate mechanisms and treatment strategies for these associated conditions. The goal of this study was to determine the association of cognitive dysfunction with depression-like behaviour in an animal model of depression and investigate the neural circuits underlying the behaviour. Mice that were exposed to social defeat for 14 d developed depression-like behaviour, i.e. anhedonia and social avoidance as indicated by reduced sucrose preference and decreased social interaction. The assessment of cognitive performance of defeated mice demonstrated impaired working memory in the T-maze continuous alternation task and enhanced fear memory in the contextual and cued fear-conditioning tests. In contrast, reference learning and memory in the Morris water maze test were intact in defeated mice. Neuronal activation following chronic social defeat was investigated by c-fosin-situ hybridization. Defeated mice exhibited preferential neural activity in the prefrontal cortex, cingulate cortex, hippocampal formation, septum, amygdala, and hypothalamic nuclei. Taken together, our results suggest that the chronic social defeat mouse model could serve as a valid animal model to study depression with cognitive impairments. The patterns of neuronal activation provide a neural basis for social defeat-induced changes in behaviour.

Falls risk among a very old home-dwelling population

PubMed Central

Iinattiniemi, Sari; Jokelainen, Jari; Luukinen, Heikki

2009-01-01

Objective The aim of this prospective study was to examine risk factors of falling in a very old home-dwelling population. Design A prospective study of home-dwelling elderly people. Methods Baseline data were collected by home-nursing staff through postal questionnaires and clinical tests. Data on falls were recorded in telephone interviews every other month during a follow-up of 11 months constituting 494 person years (PY). Negative binomial modeling was used to assess fall risk. Setting General community. Subjects A population sample of home-dwelling subjects aged 85 years or older (n = 555). Main outcome measures Fall rate and risk factors of falls. Results Altogether 512 falls occurred in 273 (49%) subjects, incidence rate 1.03/PY. According to a multivariate model, history of recurrent falling, trouble with vision when moving, use of antipsychotic drug, and feelings of anxiety, nervousness, or fear were independent risk factors for subsequent falls. Conclusion Appropriate care of poor vision and feelings of anxiety, nervousness, or fear, and avoidance of use of antipsychotic drugs might be useful in the prevention of falls among the most elderly home-dwellers. PMID:19065453

Linking Fearfulness and Coping Styles in Fish

PubMed Central

Martins, Catarina I. M.; Silva, Patricia I. M.; Conceição, Luis E. C.; Costas, Benjamin; Höglund, Erik; Øverli, Øyvind; Schrama, Johan W.

2011-01-01

Consistent individual differences in cognitive appraisal and emotional reactivity, including fearfulness, are important personality traits in humans, non-human mammals, and birds. Comparative studies on teleost fishes support the existence of coping styles and behavioral syndromes also in poikilothermic animals. The functionalist approach to emotions hold that emotions have evolved to ensure appropriate behavioral responses to dangerous or rewarding stimuli. Little information is however available on how evolutionary widespread these putative links between personality and the expression of emotional or affective states such as fear are. Here we disclose that individual variation in coping style predicts fear responses in Nile tilapia Oreochromis niloticus, using the principle of avoidance learning. Fish previously screened for coping style were given the possibility to escape a signalled aversive stimulus. Fearful individuals showed a range of typically reactive traits such as slow recovery of feed intake in a novel environment, neophobia, and high post-stress cortisol levels. Hence, emotional reactivity and appraisal would appear to be an essential component of animal personality in species distributed throughout the vertebrate subphylum. PMID:22140511

Looking at the heart of low and high heart rate variability fearful flyers: self-reported anxiety when confronting feared stimuli.

PubMed

Bornas, Xavier; Llabrés, Jordi; Noguera, Miquel; López, Ana Ma; Barceló, Francesca; Tortella-Feliu, Miquel; Fullana, Miquel Angel

2005-12-01

Previous research has shown that phobic subjects with low heart rate variability (HRV) are less able to inhibit an inappropriate response when confronted with threatening words compared to phobic subjects with high HRV [Johnsen, B.H., Thayer, J.F., Laberg, J.C., Wormnes, B., Raadal, M., Skaret, E., et al., 2003. Attentional and physiological characteristics of patients with dental anxiety. Journal of Anxiety Disorders, 17, 75-87]. The aim of this study was to evaluate changes in self-reported anxiety when low HRV and high HRV fearful flyers (N=15) and a matched control group (N=15) were exposed to flight-related pictures, flight-related sounds or both pictures and sounds. We hypothesized that sounds would be crucial to evoke fear. Also, low HRV fearful flyers were expected to report higher anxiety than high HRV fearful flyers assuming anxiety as their inappropriate response. Decreases on HRV measures were also predicted for a subgroup of phobic participants (N=10) when confronted with the feared stimuli. Our data supported the hypothesis that sounds are crucial in this kind of phobia. Low HRV fearful flyers reported higher anxiety than high HRV fearful flyers in two out of three aversive conditions. The predicted HRV decreases were not found in this study. Results are discussed in the context of avoidance of exposure-based treatments.

Social Anxiety Disorder (Social Phobia)

MedlinePlus

... other activities. Social anxiety disorder is a chronic mental health condition, but learning coping skills in psychotherapy and ... to see a doctor See your doctor or mental health professional if you fear and avoid normal social ...

Enhanced anandamide signaling reduces flight behavior elicited by an approaching robo-beetle.

PubMed

Heinz, Daniel E; Genewsky, Andreas; Wotjak, Carsten T

2017-11-01

Our current knowledge of the implications of endocannabinoids in fear and anxiety is largely based on fear conditioning paradigms and approach-avoidance conflicts. Here we establish the ethobehavioral beetle mania task (BMT), which confronts mice with an erratically moving robo-beetle. With the help of this task we demonstrate decreased tolerance yet increased avoidance responses to an approaching beetle in high-anxiety behavior (HAB) and BALBc mice compared to C57BL/6N, CD1 and normal-anxiety behavior (NAB) mice. Also DBA/2N mice showed decreased passive and increased active behavior, but followed the robo-beetle more often than HAB and BALBc mice. Treatment with diazepam (1 mg/kg) increased tolerance without affecting avoidance behavior in HAB mice. Treatment with the MAGL inhibitor JZL184 (8 mg/kg) increased flight behavior, but did not affect tolerance. The FAAH inhibitor URB597 (0.3 mg/kg), however, reduced flight behavior and enhanced tolerance to the robo-beetle. The latter effects were blocked by co-treatment with the CB1 receptor antagonist SR141716A (3 mg/kg), which failed to affect the behavior by itself. Taken together, we validate the BMT as a novel test for studying endocannabinoids beyond traditional paradigms and for assessing active fear responses in mice. Furthermore, we demonstrate panicolytic consequences of pharmacological enhancement of anandamide, but not 2-AG signaling. Copyright © 2017 Elsevier Ltd. All rights reserved.

Some Findings of the Viet Cong Motivation and Morale Study: June-December 1965

DTIC Science & Technology

1966-02-01

An Evaluation of Chemical Crop Destruction in Vietnam, R. Betts, F. Deiton, October 1967. RM-5450-1 A Statistical Analysis of the U.S. Crop Spraying...advantage of surprise, of superior numbers, and of being dug in, while the ARVN must fight in the open. DEFOLIATION Fear of chemical spray continued to...the impression that the Americans were making extensive use of chemical warfare. The Viet Cong appear to avoid defoliated areas from fear of detec

A critical examination of factors that might encourage secrecy

NASA Astrophysics Data System (ADS)

Tough, Allen

1987-10-01

Seven factors that may encourage a government to keep secret a signal from extraterrestrial intelligence are critically examined. These factors are: (1) belief that people may panic; (2) fear of a negative impact on religion, science, and culture; (3) embarrassment; (4) individual and national competitive urges; (5) avoiding a harmful premature reply; (6) a national trade or military advantage; and (7) fear of a Trojan horse. Steps that can be taken to alleviate the most significant of these factors are considered.

Business or pleasure? Utilitarian versus hedonic considerations in emotion regulation.

PubMed

Tamir, Maya; Chiu, Chi-Yue; Gross, James J

2007-08-01

It is widely accepted that emotions have utilitarian as well as hedonic consequences. Nevertheless, it is typically assumed that individuals regulate emotions to obtain hedonic, rather than utilitarian, benefits. In this study, the authors tested whether individuals represent the utility of pleasant and unpleasant emotions and whether they would be motivated to experience unpleasant emotions if they believed they could be useful. First, findings revealed that participants explicitly viewed approach emotions (e.g., excitement) as useful for obtaining rewards, but viewed avoidance emotions (e.g., worry) as useful for avoiding threats. Second, this pattern was replicated in implicit representations of emotional utility, which were dissociated from explicit ones. Third, implicit, but not explicit, representations of emotional utility predicted motives for emotion regulation. When anticipating a threatening task, participants who viewed emotions such as worry and fear as useful for avoiding threats preferred to engage in activities that were likely to increase worry and fear (vs. excitement) before the task. These findings demonstrate that utilitarian considerations play an important, if underappreciated, role in emotion regulation. ((c) 2007 APA, all rights reserved).

Generalization of Pain-Related Fear Based on Conceptual Knowledge.

PubMed

Meulders, Ann; Vandael, Kristof; Vlaeyen, Johan W S

2017-05-01

Increasing evidence suggests that pain-related fear is key to the transition from acute to chronic pain. Previous research has shown that perceptual similarity with a pain-associated movement fosters the generalization of fear to novel movements. Perceptual generalization of pain-related fear is adaptive as it enables individuals to extrapolate the threat value of one movement to another without the necessity to learn anew. However, excessive spreading of fear to safe movements may become maladaptive and may lead to sustained anxiety, dysfunctional avoidance behaviors, and severe disability. A hallmark of human cognition is the ability to extract conceptual knowledge from a learning episode as well. Although this conceptual pathway may be important to understand fear generalization in chronic pain, research on this topic is lacking. We investigated acquisition and generalization of concept-based pain-related fear. During acquisition, unique exemplars of one action category (CS+; e.g., opening boxes) were followed by pain, whereas exemplars of another action category (CS-; e.g., closing boxes) were not. Subsequently, spreading of pain-related fear to novel exemplars of both action categories was tested. Participants learned to expect the pain to occur and reported more pain-related fear to the exemplars of the CS+ category compared with those of the CS- category. During generalization, fear and expectancy generalized to novel exemplars of the CS+ category, but not to the CS- category. This pattern was not corroborated in the eyeblink startle measures. This is the first study that demonstrates that pain-related fear can be acquired and generalized based on conceptual knowledge. Copyright © 2016. Published by Elsevier Ltd.

Threatening social context facilitates pain-related fear learning.

PubMed

Karos, Kai; Meulders, Ann; Vlaeyen, Johan W S

2015-03-01

This study investigated the effects of a threatening and a safe social context on learning pain-related fear, a key factor in the development and maintenance of chronic pain. We measured self-reported pain intensity, pain expectancy, pain-related fear (verbal ratings and eyeblink startle responses), and behavioral measures of avoidance (movement-onset latency and duration) using an established differential voluntary movement fear conditioning paradigm. Participants (N = 42) performed different movements with a joystick: during fear acquisition, movement in one direction (CS+) was followed by a painful stimulus (pain-US) whereas movement in another direction (CS-) was not. For participants in the threat group, an angry face was continuously presented in the background during the task, whereas in the safe group, a happy face was presented. During the extinction phase the pain-US was omitted. As compared to the safe social context, a threatening social context led to increased contextual fear and facilitated differentiation between CS+ and CS- movements regarding self-reported pain expectancy, fear of pain, eyeblink startle responses, and movement-onset latency. In contrast, self-reported pain intensity was not affected by social context. These data support the modulation of pain-related fear by social context. A threatening social context leads to stronger acquisition of (pain-related) fear and simultaneous contextual fear but does not affect pain intensity ratings. This knowledge may aid in the prevention of chronic pain and anxiety disorders and shows that social context might modulate pain-related fear without immediately affecting pain intensity itself. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

Cumulative childhood interpersonal trauma is associated with reduced cortical differentiation between threat and non-threat faces in posttraumatic stress disorder adults.

PubMed

Chu, Denise A; Bryant, Richard A; Gatt, Justine M; Harris, Anthony Wf

2018-03-01

Posttraumatic stress disorder and childhood trauma frequently co-occur. Both are associated with abnormal neural responses to salient emotion stimuli. As childhood trauma is a risk factor for posttraumatic stress disorder, differentiating between their neurophysiological effects is necessary to elucidate the neural pathways by which childhood trauma exposure contributes to increased posttraumatic stress disorder risks. Face-specific N170 evoked response potentials for backward-masked (non-conscious) and conscious threat (fear, angry) and non-threat (happy) faces were measured in 77 adults (18-64 years old, 64% women, 78% right-handed) symptomatic for posttraumatic stress disorder. Differences in N170 peak amplitudes for fear-versus-happy and angry-versus-happy faces at bilateral temporo-occipital (T5, T6) sites were computed. The effect of cumulative exposure to childhood interpersonal trauma, other childhood trauma, adult trauma, depression and posttraumatic stress disorder symptom severity on the N170 response was assessed using hierarchical multiple regression analyses. T5 N170 peak amplitudes for non-conscious fear-versus-happy faces were inversely related to cumulative childhood interpersonal trauma after accounting for socio-demographic, clinical symptom and other trauma factors. Posttraumatic stress disorder Avoidance was positively associated with N170 peak amplitudes for non-conscious fear-versus-happy faces, primarily due to reduced N170 responsivity to happy faces. Childhood interpersonal trauma exposure is associated with reduced discrimination between fear and happy faces, while avoidance symptom severity is associated with dampened responsivity to automatically processed happy faces in posttraumatic stress disorder adults. Results are discussed in terms of the likely contributions of impaired threat discrimination and deficient reward processing during neural processing of salient emotion stimuli, to increased risks of posttraumatic stress disorder onset and chronicity in childhood interpersonal trauma-exposed adults.

Bio-psychosocial factors are associated with pain intensity, physical functioning, and ability to work in female healthcare personnel with recurrent low back pain.

PubMed

Taulaniemi, Annika; Kuusinen, Lotta; Tokola, Kari; Kankaanpää, Markku; Suni, Jaana H

2017-08-31

To investigate associations of various bio-psychosocial factors with bodily pain, physical func-tioning, and ability to work in low back pain. Cross-sectional study. A total of 219 female healthcare workers with recurrent non-specific low back pain. Associations between several physical and psychosocial factors and: (i) bodily pain, (ii) physical functioning and (iii) ability to work were studied. Variables with statistically significant associations (p < 0.05) in bivariate analysis were set within a generalized linear model to analyse their relationship with each dependent variable. In generalized linear model analysis, perceived work-induced lumbar exertion (p < 0.001), multi-site pain (p <0.001) and work-related fear-avoidance beliefs (FAB-W) (p = 0.02) best explained bodily pain. Multi-site pain (p < 0.001), lumbar exertion (p = 0.005), FAB-W (p = 0.01) and physical performance in figure-of-eight running (p = 0.01) and modified push-ups (p = 0.05) best explained physical functioning; FAB-W (p <0.001), lumbar exertion (p = 0.003), depression (p = 0.01) and recovery after work (p = 0.03) best explained work ability. In bivariate analysis lumbar exertion was associated with poor physical performance. FAB-W and work-induced lumbar exertion were associated with levels of pain, physical functioning and ability to work. Poor physical performance capacity was associated with work-induced lumbar exertion. Interventions that aim to reduce fear-avoidance and increase fitness capacity might be beneficial.

Oral Health, Nutritional Choices, and Dental Fear and Anxiety

PubMed Central

Beaudette, Jennifer R.; Fritz, Peter C.; Sullivan, Philip J.; Ward, Wendy E.

2017-01-01

Oral health is an integral part of overall health. Poor oral health can lead to an increased risk of chronic diseases including diabetes mellitus, cardiovascular disease, and some types of cancer. The etiology of these diseases could be linked to the individual’s inability to eat a healthy diet when their dentition is compromised. While periodontal or implant surgery may be necessary to reconstruct tissue around natural teeth or replace missing teeth, respectively, some individuals avoid such interventions because of their associated fear and anxiety. Thus, while the relationship between poor oral health, compromised nutritional choices and fear and anxiety regarding periodontal procedures is not entirely new, this review provides an up-to-date summary of literature addressing aspects of this complex relationship. This review also identifies potential strategies for clinicians to help their patients overcome their fear and anxiety associated with dental treatment, and allow them to seek the care they need. PMID:29563414

Avoiding antiperspirants during breast radiation therapy: Myth or sound advice?

PubMed

Baumann, Brian C; Zeng, Chuan; Freedman, Gary M; Verginadis, Ioannis I; MacArthur, Kelly M; Lin, Lilie L; Vachani, Carolyn; Koumenis, Constantinos; Solberg, Timothy D; Metz, James M

2017-08-01

Breast cancer patients are typically advised to avoid antiperspirants for fear of increasing radiation dermatitis in the axilla. We hypothesized that antiperspirants would have minimal effect on skin dose. We found no difference in surface dose±antiperspirants using 6MV photons at gantry angles of 0°/30°/60°/90° regardless of aluminum concentration. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparative behavioral effects between synthetic 2,4,5-trimethylthiazoline (TMT) and the odor of natural fox (Vulpes vulpes) feces in mice.

PubMed

Buron, Gaelle; Hacquemand, Romain; Pourie, Gregory; Lucarz, Annie; Jacquot, Laurence; Brand, Gerard

2007-10-01

Synthetic 2,4,5-trimethylthiazoline (TMT)--a component of red fox (Vulpes vulpes) feces--is frequently used to induce unconditioned fear in rodents. Surprisingly, direct comparison between TMT and natural fox feces odor is almost nonexistent. In this study, Experiment 1 compared the avoidance in relation to TMT concentration, natural fox feces, and gender of fox and mice. Results show that the avoidance is (a) higher with either pure or 50% TMT as compared to natural fox feces, whereas the difference is slight with 10% TMT, and (b) significantly higher for the female mouse group compared to the male mouse group with TMT as well as natural fox feces. In addition, no clear difference in effect was observed between male and female fox feces. Experiment 2 compared behavioral parameters recorded as an index of fear and anxiety, general activity, and avoidance in elevated plus-maze and open-field chamber between 10% TMT and natural fox feces in relation to the estrus cycle of the mice. Results show no cycle period effect--except for the avoidance parameter "distance to odorant"--and no different effects between 10% TMT and natural fox feces except for freezing. (PsycINFO Database Record (c) 2007 APA, all rights reserved).

Experiences of fear of falling in persons with Parkinson's disease - a qualitative study.

PubMed

Jonasson, Stina B; Nilsson, Maria H; Lexell, Jan; Carlsson, Gunilla

2018-02-06

Fear of falling is common among persons with Parkinson's disease and is negatively associated with quality of life. However a lack of in-depth understanding of fear of falling as a phenomenon persists. This qualitative study aimed to explore the experiences of fear of falling in persons with Parkinson's disease. Individual interviews were performed with twelve persons with Parkinson's disease (median age 70 years, median Parkinson duration 9 years, 50% women). The interviews were semi-structured and followed a study-specific interview guide. The transcribed interviews were analyzed using qualitative content analysis. Fear of falling was experienced as a disturbing factor in everyday life. It generated a feeling of vulnerability and made daily activities and everyday environments seem potentially hazardous. Persons also missed performing previous activities. The fear of falling was a varying experience, fueled by an awareness of falls and near falls, Parkinson-related symptoms and disabilities, and by others in their environment. The persons adopted different strategies to handle their fear of falling. Activities were adapted, avoided, performed with help, or carried out despite their fear of falling. The experiences of fear of falling were complex, multifaceted and varied over time and in relation to different activities and environments. This indicates that interventions targeting fear of falling need to be individually tailored for persons with Parkinson's disease and should focus on several aspects, such as Parkinson-related symptoms and disabilities, activities and environmental factors. This study provides new information that increases the understanding of fear of falling, which has implications for researchers as well as clinicians working with persons with Parkinson's disease and fear of falling.

Less is more: Neural activity during very brief and clearly visible exposure to phobic stimuli.

PubMed

Siegel, Paul; Warren, Richard; Wang, Zhishun; Yang, Jie; Cohen, Don; Anderson, Jason F; Murray, Lilly; Peterson, Bradley S

2017-05-01

Research on automatic processes in fear has emphasized the provocation of fear responses rather than their attenuation. We have previously shown that the repeated presentation of feared images without conscious awareness via backward masking reduces avoidance of a live tarantula in spider-phobic participants. Herein we investigated the neural basis for these adaptive effects of masked exposure. 21 spider-phobic and 21 control participants, identified by a psychiatric interview, fear questionnaire, and approaching a live tarantula, viewed stimuli in each of three conditions: (1) very brief exposure (VBE) to masked images of spiders, severely limited awareness; (2) clearly visible exposure (CVE) to spiders, full awareness; and (3) masked images of flowers (control), severely limited awareness. Only VBE to masked spiders generated neural activity more strongly in phobic than in control participants, within subcortical fear, attention, higher-order language, and vision systems. Moreover, VBE activated regions that support fear processing in phobic participants without causing them to experience fear consciously. Counter-intuitively, CVE to the same spiders generated stronger neural activity in control rather than phobic participants within these and other systems. CVE deactivated regions supporting fear regulation and caused phobic participants to experience fear. CVE-induced activations also correlated with measures of explicit fear ratings, whereas VBE-induced activations correlated with measures of implicit fear (color-naming interference of spider words). These multiple dissociations between the effects of VBE and CVE to spiders suggest that limiting awareness of exposure to phobic stimuli through visual masking paradoxically facilitates their processing, while simultaneously minimizing the experience of fear. Hum Brain Mapp 38:2466-2481, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Opioid system and human emotions.

PubMed

Nummenmaa, Lauri; Tuominen, Lauri

2017-04-10

Emotions are states of vigilant readiness that guide human and animal behaviour during survival-salient situations. Categorical models of emotions posit neurally and physiologically distinct basic human emotions (anger, fear, disgust, happiness, sadness and surprise) that govern different survival functions. Opioid receptors are expressed abundantly in the mammalian emotion circuit, and the opioid system modulates a variety of functions related to arousal and motivation. Yet, its specific contribution to different basic emotions has remained poorly understood. Here, we review how the endogenous opioid system and particularly the μ receptor contribute to emotional processing in humans. Activation of the endogenous opioid system is consistently associated with both pleasant and unpleasant emotions. In general, exogenous opioid agonists facilitate approach-oriented emotions (anger, pleasure) and inhibit avoidance-oriented emotions (fear, sadness). Opioids also modulate social bonding and affiliative behaviour, and prolonged opioid abuse may render both social bonding and emotion recognition circuits dysfunctional. However, there is no clear evidence that the opioid system is able to affect the emotions associated with surprise and disgust. Taken together, the opioid systems contribute to a wide array of positive and negative emotions through their general ability to modulate the approach versus avoidance motivation associated with specific emotions. Because of the protective effects of opioid system-mediated prosociality and positive mood, the opioid system may constitute an important factor contributing to psychological and psychosomatic resilience. © 2017 The British Pharmacological Society.

Retrospective reports of parenting received in their families of origin: relationships to adult attachment in adult children of alcoholics.

PubMed

Kelley, Michelle L; Nair, Veena; Rawlings, Tanaya; Cash, Thomas F; Steer, Kate; Fals-Stewart, William

2005-09-01

The present study examined general and romantic attachment and parenting students received in their families of origin among 401 college students who resided with an alcohol-abusing parent prior to age 16 years as compared to those who did not reside with alcohol-abusing parents. Participants completed the Children's Report of Parent Behavior Instrument [Schludermann, E. and Schludermann, S. (1970). Children's Report of Parent Behavior Inventory (CRPBI). Canada: University of Manitoba], Experiences in Close Relationships--Revised [Fraley, R. C., Waller, N. G., and Brennan, K. G. (2000). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350-365], Relationship Scale Questionnaire [Griffin, D. W. and Bartholomew, K. (1994). Models of the self and other: Fundamental dimensions underlying measures of adult attachment. Journal of Personality and Social Psychology, 67, 430-445], and the Children of Alcoholics Screening Test [Jones, J. W. (1983). The Children of Alcoholics Screening Test: Test manual. Chicago: Camelot]. Young adults who met criteria for ACOAs reported more anxious and avoidant behavior in romantic relationships and a more fearful style of general adult attachment. Parenting behavior in one's family of origin predicted anxious behavior in romantic relationships and a fearful overall style of attachment, whereas being an ACOA and parenting in one's family of origin predicted avoidant behavior in romantic relationships.

Needs and fears of young people presenting at accident and emergency department following an act of self-harm: secondary analysis of qualitative data.

PubMed

Owens, Christabel; Hansford, Lorraine; Sharkey, Siobhan; Ford, Tamsin

2016-03-01

Presentation at an accident and emergency (A&E) department is a key opportunity to engage with a young person who self-harms. The needs of this vulnerable group and their fears about presenting to healthcare services, including A&E, are poorly understood. To examine young people's perceptions of A&E treatment following self-harm and their views on what constitutes a positive clinical encounter. Secondary analysis of qualitative data from an experimental online discussion forum. Threads selected for secondary analysis represent the views of 31 young people aged 16-25 with experience of self-harm. Participants reported avoiding A&E whenever possible, based on their own and others' previous poor experiences. When forced to seek emergency care, they did so with feelings of shame and unworthiness. These feelings were reinforced when they received what they perceived as punitive treatment from A&E staff, perpetuating a cycle of shame, avoidance and further self-harm. Positive encounters were those in which they received 'treatment as usual', i.e. non-discriminatory care, delivered with kindness, which had the potential to challenge negative self-evaluation and break the cycle. The clinical needs of young people who self-harm continue to demand urgent attention. Further hypothesis testing and trials of different models of care delivery for this vulnerable group are warranted. © The Royal College of Psychiatrists 2016.

Is that disgust I see? Political ideology and biased visual attention.

PubMed

Oosterhoff, Benjamin; Shook, Natalie J; Ford, Cameron

2018-01-15

Considerable evidence suggests that political liberals and conservatives vary in the way they process and respond to valenced (i.e., negative versus positive) information, with conservatives generally displaying greater negativity biases than liberals. Less is known about whether liberals and conservatives differentially prioritize certain forms of negative information over others. Across two studies using eye-tracking methodology, we examined differences in visual attention to negative scenes and facial expressions based on self-reported political ideology. In Study 1, scenes rated high in fear, disgust, sadness, and neutrality were presented simultaneously. Greater endorsement of socially conservative political attitudes was associated with less attentional engagement (i.e., lower dwell time) of disgust scenes and more attentional engagement toward neutral scenes. Socially conservative political attitudes were not significantly associated with visual attention to fear or sad scenes. In Study 2, images depicting facial expressions of fear, disgust, sadness, and neutrality were presented simultaneously. Greater endorsement of socially conservative political attitudes was associated with greater attentional engagement with facial expressions depicting disgust and less attentional engagement toward neutral faces. Visual attention to fearful or sad faces was not related to social conservatism. Endorsement of economically conservative political attitudes was not consistently associated with biases in visual attention across both studies. These findings support disease-avoidance models and suggest that social conservatism may be rooted within a greater sensitivity to disgust-related information. Copyright © 2017 Elsevier B.V. All rights reserved.

[Study of fear of dental treatments in pediatrics in Sénegal].

PubMed

Faye, M; Yama, A; Gueye-Diagne, M C; Ba, I

2004-01-01

Fear and anxiety of dental treatment have been recognized as a major source of a problems in pediatric dentistry. They can prevent dental procedure and lead to avoidance an dental phobia. A variaty of studies, using psychometric methods have been carried out worldwide to evaluate these behavious. In Senegal, no study of this nature has been done yet. The aim of this study was to evaluate fear and anxiety related to dental care in senegaleese pediatric children living in Dakar. We have used the children's Fear survey Schedule Dental Sb scale (CFSS-DS) in 415 senegalese children of both sex with a age anking from 7 to 15 years. The results showed a mean score of 33.222 +/- 11.162. Girls revealed a significant higher score (35.122 +/- 11.692) than boys (29.168 +/- 9.704) (p < 0.05). These mean score increase with age in both boys than girl. In addition, more than 43.5% of the children have never consulted a dentist previously and 28% among them showed fear of the dentist. 17% of the children who have dental experiences showed fear of the dentist. This study has showed that senegalease children revealed fear of the dental care even those who have never been to a dentist. It also point out the problem of the origine of dental fear in children.

Terrorism-related fear and avoidance behavior in a multiethnic urban population.

PubMed

Eisenman, David P; Glik, Deborah; Ong, Michael; Zhou, Qiong; Tseng, Chi-Hong; Long, Anna; Fielding, Jonathan; Asch, Steven

2009-01-01

We sought to determine whether groups traditionally most vulnerable to disasters would be more likely than would be others to perceive population-level risk as high (as measured by the estimated color-coded alert level) would worry more about terrorism, and would avoid activities because of terrorism concerns. We conducted a random digit dial survey of the Los Angeles County population October 2004 through January 2005 in 6 languages. We asked respondents what color alert level the country was under, how often they worry about terrorist attacks, and how often they avoid activities because of terrorism. Multivariate regression modeled correlates of worry and avoidance, including mental illness, disability, demographic factors, and estimated color-coded alert level. Persons who are mentally ill, those who are disabled, African Americans, Latinos, Chinese Americans, Korean Americans, and non-US citizens were more likely to perceive population-level risk as high, as measured by the estimated color-coded alert level. These groups also reported more worry and avoidance behaviors because of concerns about terrorism. Vulnerable populations experience a disproportionate burden of the psychosocial impact of terrorism threats and our national response. Further studies should investigate the specific behaviors affected and further elucidate disparities in the disaster burden associated with terrorism and terrorism policies.

Terrorism-Related Fear and Avoidance Behavior in a Multiethnic Urban Population

PubMed Central

Glik, Deborah; Ong, Michael; Zhou, Qiong; Tseng, Chi-Hong; Long, Anna; Fielding, Jonathan; Asch, Steven

2009-01-01

Objectives. We sought to determine whether groups traditionally most vulnerable to disasters would be more likely than would be others to perceive population-level risk as high (as measured by the estimated color-coded alert level) would worry more about terrorism, and would avoid activities because of terrorism concerns. Methods. We conducted a random digit dial survey of the Los Angeles County population October 2004 through January 2005 in 6 languages. We asked respondents what color alert level the country was under, how often they worry about terrorist attacks, and how often they avoid activities because of terrorism. Multivariate regression modeled correlates of worry and avoidance, including mental illness, disability, demographic factors, and estimated color-coded alert level. Results. Persons who are mentally ill, those who are disabled, African Americans, Latinos, Chinese Americans, Korean Americans, and non-US citizens were more likely to perceive population-level risk as high, as measured by the estimated color-coded alert level. These groups also reported more worry and avoidance behaviors because of concerns about terrorism. Conclusions. Vulnerable populations experience a disproportionate burden of the psychosocial impact of terrorism threats and our national response. Further studies should investigate the specific behaviors affected and further elucidate disparities in the disaster burden associated with terrorism and terrorism policies. PMID:19008521

Construction of a pulse-coupled dipole network capable of fear-like and relief-like responses

NASA Astrophysics Data System (ADS)

Lungsi Sharma, B.

2016-07-01

The challenge for neuroscience as an interdisciplinary programme is the integration of ideas among the disciplines to achieve a common goal. This paper deals with the problem of deriving a pulse-coupled neural network that is capable of demonstrating behavioural responses (fear-like and relief-like). Current pulse-coupled neural networks are designed mostly for engineering applications, particularly image processing. The discovered neural network was constructed using the method of minimal anatomies approach. The behavioural response of a level-coded activity-based model was used as a reference. Although the spiking-based model and the activity-based model are of different scales, the use of model-reference principle means that the characteristics that is referenced is its functional properties. It is demonstrated that this strategy of dissection and systematic construction is effective in the functional design of pulse-coupled neural network system with nonlinear signalling. The differential equations for the elastic weights in the reference model are replicated in the pulse-coupled network geometrically. The network reflects a possible solution to the problem of punishment and avoidance. The network developed in this work is a new network topology for pulse-coupled neural networks. Therefore, the model-reference principle is a powerful tool in connecting neuroscience disciplines. The continuity of concepts and phenomena is further maintained by systematic construction using methods like the method of minimal anatomies.

Assessing competition avoidance as a basic personality dimension.

PubMed

Ryckman, Richard M; Thornton, Bill; Gold, Joel A

2009-03-01

The lack of an adequate psychometric instrument has impeded personality theory testing in the area of competition avoidance. The authors conducted 6 studies in an attempt to remedy this deficiency by constructing an individual-difference measure of competition avoidance. In line with K. Horney's (1937) interpersonal theory of neurosis, participants who were higher in competition avoidance showed higher levels of neuroticism, greater fears of both success and failure, a lower desire to prove themselves in competitive situations, higher levels of self-handicapping, and more maladaptiveness than those participants who were lower in competition avoidance. Also, they were more modest and willing to conform to group standards than were those lower in competition avoidance. The authors discuss the measure's potential usefulness as a diagnostic and assessment tool in academic, athletic, and clinical settings.

Fear or disgust? The role of emotions in spider phobia and blood-injection-injury phobia.

PubMed

Çavuşoğlu, Merve; Dirik, Gülay

2011-01-01

According to the literature, it is assumed that fear and anxiety are basic emotions in anxiety disorders. Many recent studies report that disgust, as well as fear, has an important role in the etiology and maintenance of anxiety disorders. Evaluation of the role of disgust in anxiety disorders has led the theoretical and empirical literature in a new direction, beyond the traditional emphasis on fear. Most of this basic research has focused on specific phobias, such as blood-injection-injury phobia and spider phobia. Findings obtained from evaluation of physiological and cognitive processes, and subjective and behavioral experiences clearly show that in addition to fear, emotional reactions to phobic stimuli also include disgust; however, empirical studies show that disgust and fear have different relative impacts on specific phobias. To illustrate, individuals experience disgust as the basic emotion in blood-injection-injury phobia, whereas both fear and disgust are experienced in spider phobia. Nevertheless, it is concluded that fear has a more fundamental role in the latter. Yet, research indicates that basic emotions different from those identified from neural structures or physiological responses, such as heart rate, can be identified if facial expressions and cognitive appraisals are taken into account. In the present review the role of fear and disgust in blood-injection-injury phobia vs. spider phobia are discussed, based on the relationship between the phobias and disgust sensitivity, disgust as part of phobic responses, and disgust-motivated avoidance behavior.

Deep brain stimulation of the ventral striatum enhances extinction of conditioned fear

PubMed Central

Rodriguez-Romaguera, Jose; Do Monte, Fabricio H. M.; Quirk, Gregory J.

2012-01-01

Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) reduces symptoms of intractable obsessive-compulsive disorder (OCD), but the mechanism of action is unknown. OCD is characterized by avoidance behaviors that fail to extinguish, and DBS could act, in part, by facilitating extinction of fear. We investigated this possibility by using auditory fear conditioning in rats, for which the circuits of fear extinction are well characterized. We found that DBS of the VS (the VC/VS homolog in rats) during extinction training reduced fear expression and strengthened extinction memory. Facilitation of extinction was observed for a specific zone of dorsomedial VS, just above the anterior commissure; stimulation of more ventrolateral sites in VS impaired extinction. DBS effects could not be obtained with pharmacological inactivation of either dorsomedial VS or ventrolateral VS, suggesting an extrastriatal mechanism. Accordingly, DBS of dorsomedial VS (but not ventrolateral VS) increased expression of a plasticity marker in the prelimbic and infralimbic prefrontal cortices, the orbitofrontal cortex, the amygdala central nucleus (lateral division), and intercalated cells, areas known to learn and express extinction. Facilitation of fear extinction suggests that, in accord with clinical observations, DBS could augment the effectiveness of cognitive behavioral therapies for OCD. PMID:22586125

Psychiatric stigma in the military.

PubMed

Porter, T L; Johnson, W B

1994-09-01

There is potential for the stigma of mental health care to directly affect an active duty member's career. The authors are aware of cases in which fear of adverse career consequences has led service members to avoid needed mental health care. In order to investigate the legitimacy of this fear, the authors surveyed 252 USN and USMC commanding and executive officers concerning their attitudes about service members who had received mental health and other services; 138 responded. Overall the responses were neutral and there were relatively few negative evaluations of service members who had received services. Military health care providers should take an active role in diminishing the stigma of mental illness, and in allaying fears of adverse career consequences for seeking care.

Context conditioning and behavioral avoidance in a virtual reality environment: effect of predictability.

PubMed

Grillon, Christian; Baas, Johanna M P; Cornwell, Brian; Johnson, Linda

2006-10-01

Sustained anxiety can be modeled using context conditioning, which can be studied in a virtual reality environment. Unpredictable stressors increase context conditioning in animals. This study examined context conditioning to predictable and unpredictable shocks in humans using behavioral avoidance, potentiated startle, and subjective reports of anxiety. Subjects were guided through three virtual rooms (no-shock, predictable, unpredictable contexts). Eight-sec duration colored lights served as conditioned stimuli (CS). During acquisition, no shock was administered in the no-shock context. Shocks were paired with the CS in the predictable context and were administered randomly in the unpredictable context. No shock was administered during extinction. Startle stimuli were delivered during CS and between CS to assess cued and context conditioning, respectively. To assess avoidance, subjects freely navigated into two of the three contexts to retrieve money. Startle between CS was potentiated in the unpredictable context compared to the two other contexts. Following acquisition, subjects showed a strong preference for the no-shock context and avoidance of the unpredictable context. Consistent with animal data, context conditioning is increased by unpredictability. These data support virtual reality as a tool to extend research on physiological and behavioral signs of fear and anxiety in humans.

Don't look now! Oculomotor avoidance as a conditioned disgust response.

PubMed

Armstrong, Thomas; McClenahan, Laura; Kittle, Jody; Olatunji, Bunmi O

2014-02-01

Pavlovian conditioning paradigms have revealed fear learning tendencies that may be implicated in the etiology and maintenance of anxiety disorders. Given the prominence of disgust in certain anxiety disorders, it may be fruitful to study disgust learning in addition to fear learning. The present study utilized eye tracking to examine the effects of disgust conditioning on attentional bias, a phenomenon that characterizes anxiety disorders. Participants completed either a disgust condition, in which a face (conditioned stimulus; CS+) was paired with videos of individuals vomiting (unconditioned stimulus; US), or a negative condition in which a face was paired with videos of individuals being harmed in motor-vehicle accidents. Eye movements were used to measure attentional biases related to the USs and the CSs. In line with prior research, attentional avoidance was observed for the disgust CS+. However, this effect did not reach significance until after extinction and was linked to self-reported disgust postacquisition, yet decoupled from self-reported disgust postextinction. Attentional avoidance of the CS+ was not found in the negative condition, and postextinction differences in attentional bias for the CS+ between conditions were found to be mediated by differences in attentional bias for the US, as only the disgust US elicited attentional avoidance. Also, individual differences in disgust sensitivity were found to be associated with attentional avoidance of the disgust US, and this effect was mediated by self-reported disgust in response to the US. Further, disgust sensitivity was associated with attentional avoidance of the disgust CS+, and this effect was mediated by attentional avoidance of the disgust US. These findings provide new insight into a complex pattern of relations between disgust, evaluative learning, and attention that may have implications for the etiology and maintenance of certain anxiety disorders. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Active avoidance requires inhibitory signaling in the rodent prelimbic prefrontal cortex

PubMed Central

Bravo-Rivera, Christian; Rodriguez-Romaguera, Jose; Pagan-Rivera, Pablo A; Burgos-Robles, Anthony; Roman-Ortiz, Ciorana; Quirk, Gregory J

2018-01-01

Much is known about the neural circuits of conditioned fear and its relevance to understanding anxiety disorders, but less is known about other anxiety-related behaviors such as active avoidance. Using a tone-signaled, platform-mediated avoidance task, we observed that pharmacological inactivation of the prelimbic prefrontal cortex (PL) delayed avoidance. Surprisingly, optogenetic silencing of PL glutamatergic neurons did not delay avoidance. Consistent with this, inhibitory but not excitatory responses of rostral PL neurons were associated with avoidance training. To test the importance of these inhibitory responses, we optogenetically stimulated PL neurons to counteract the tone-elicited reduction in firing rate. Photoactivation of rostral (but not caudal) PL neurons at 4 Hz impaired avoidance. These findings suggest that inhibitory responses of rostral PL neurons signal the avoidability of a potential threat and underscore the importance of designing behavioral optogenetic studies based on neuronal firing responses. PMID:29851381

When Using Facebook to Avoid Isolation Reduces Perceived Social Support.

PubMed

Lee, Eun-Ju; Cho, Eugene

2018-01-01

A survey (N = 316) examined how other-directed Facebook use driven by fear of social isolation affects users' perception of social support they possess. As predicted, those higher on fear of isolation were more likely to (a) closely monitor others' activities for self-evaluation (i.e., social comparison) and (b) regulate their self-presentation to garner social approval (i.e., other-directed self-presentation), but less likely to (c) express their true inner feelings and thoughts (i.e., inner-directed self-presentation) on Facebook. Social comparison, in turn, lowered perceived social support among heavy Facebook users, whereas inner-directed self-presentation heightened it. Other-directed self-presentation had no significant effect on perceived social support. Results indicate that the desire to avoid social isolation may paradoxically diminish perceived social support by promoting social comparison, while suppressing the expression of true self on Facebook.

[Perceptual categorization of emotional expression cued by ones back posture].

PubMed

Sogon, S; Doi, K

1986-04-01

Subjects looked at 8 mm motion pictures of the bodily movement from rear view perspective of male and female communicators, who faced to emotionally-toned scenes. If the subjects detected some sign of emotional expression, they rated the relevance of expression on five point scale. Varimax rotated factor analysis yielded three factors: F1 rejection-acceptance, F2 avoidance-approach, and F3 sadness. Rejection was categorized as expressions of anger, disgust, and contempt, while anger was categorized when a clenched fist with forward and extended arm were observed. Disgust and contempt were categorized when stationary posture was observed. Acceptance was categorized when the signs of affection, anticipation, and acceptance were observed. Avoidance was categorized when signs of fear and surprise were observed. A typical fear was categorized when signs of freezing was observed, surprise was categorized by stepping back, and sadness was categorized by crouching and self attachment.

Modeling startle eyeblink electromyogram to assess fear learning.

PubMed

Khemka, Saurabh; Tzovara, Athina; Gerster, Samuel; Quednow, Boris B; Bach, Dominik R

2017-02-01

Pavlovian fear conditioning is widely used as a laboratory model of associative learning in human and nonhuman species. In this model, an organism is trained to predict an aversive unconditioned stimulus from initially neutral events (conditioned stimuli, CS). In humans, fear memory is typically measured via conditioned autonomic responses or fear-potentiated startle. For the latter, various analysis approaches have been developed, but a systematic comparison of competing methodologies is lacking. Here, we investigate the suitability of a model-based approach to startle eyeblink analysis for assessment of fear memory, and compare this to extant analysis strategies. First, we build a psychophysiological model (PsPM) on a generic startle response. Then, we optimize and validate this PsPM on three independent fear-conditioning data sets. We demonstrate that our model can robustly distinguish aversive (CS+) from nonaversive stimuli (CS-, i.e., has high predictive validity). Importantly, our model-based approach captures fear-potentiated startle during fear retention as well as fear acquisition. Our results establish a PsPM-based approach to assessment of fear-potentiated startle, and qualify previous peak-scoring methods. Our proposed model represents a generic startle response and can potentially be used beyond fear conditioning, for example, to quantify affective startle modulation or prepulse inhibition of the acoustic startle response. © 2016 The Authors. Psychophysiology published by Wiley Periodicals, Inc. on behalf of Society for Psychophysiological Research.

Anxiety, depression, and fall-related psychological concerns in community-dwelling older people.

PubMed

Hull, Samantha L; Kneebone, Ian I; Farquharson, Lorna

2013-12-01

Establish the association between affect and fall-related psychological concerns (fear of falling, fall-related self-efficacy, balance confidence, and outcome expectancy). A total of 205 community-dwelling older people (mean age 81, SD 7.5 years) completed the Geriatric Depression Scale-15, Geriatric Anxiety Inventory, Modified Survey of Activities and Fear of Falling, Falls-Efficacy Scale- International, Activity-Specific Balance Confidence Scale, and the Consequences of Falling Scale. Hierarchical regression models showed that anxiety was independently associated with all fall-related psychological concerns; depression was only associated with falls efficacy. Associations between fall-related psychological concerns and age, gender, accommodation,medications, self-rated physical health, falls history, mobility, and sensory aids are also discussed. This is the first study that investigates the association between affect and the four fall-related psychological concerns. Anxiety was a significant factor associated with all four, whereas depression was only associated with activity avoidance. Implications for healthcare providers are discussed. Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Measuring the Cognitions, Emotions, and Motivation Associated With Avoidance Behaviors in the Context of Pain: Preliminary Development of the Negative Responsivity to Pain Scales.

PubMed

Jensen, Mark P; Ward, L Charles; Thorn, Beverly E; Ehde, Dawn M; Day, Melissa A

2017-04-01

We recently proposed a Behavioral Inhibition System-Behavioral Activation System (BIS-BAS) model to help explain the effects of pain treatments. In this model, treatments are hypothesized to operate primarily through their effects on the domains within 2 distinct neurophysiological systems that underlie approach (BAS) and avoidance (BIS) behaviors. Measures of the model's domains are needed to evaluate and modify the model. An item pool of negative responses to pain (NRP; hypothesized to be BIS related) and positive responses (PR; hypothesized to be BAS related) were administered to 395 undergraduates, 325 of whom endorsed recurrent pain. The items were administered to 176 of these individuals again 1 week later. Analyses were conducted to develop and validate scales assessing NRP and PR domains. Three NRP scales (Despondent Response to Pain, Fear of Pain, and Avoidant Response to Pain) and 2 PR scales (Happy/Hopeful Responses and Approach Response) emerged. Consistent with the model, the scales formed 2 relatively independent overarching domains. The scales also demonstrated excellent internal consistency, and associations with criterion variables supported their validity. However, whereas the NRP scales evidenced adequate test-retest stability, the 2 PR scales were not adequately stable. The study yielded 3 brief scales assessing NRP, which may be used to further evaluate the BIS-BAS model and to advance research elucidating the mechanisms of psychosocial pain treatments. The findings also provide general support for the BIS-BAS model, while also suggesting that some minor modifications in the model are warranted.

[Evaluation of a two-dimensional scale for the assessment of fear avoidance beliefs in elderly chronic low back pain patients].

PubMed

Quint, S; Raich, M; Luckmann, J

2011-06-01

There is evidence on the importance of fear avoidance beliefs (FAB) as prognostic risk factors in elderly patients suffering from chronic low back pain (CLBP). However, so far there is no validated German instrument for measuring FAB in elderly CLBP patients. The aim of the study presented was to evaluate the psychometric properties of the Catastrophizing Avoidance Scale D-65+ (CAS-D-65+) within a population of elderly patients with CLBP. A cross-sectional study was conducted with measurement repeated after 4 weeks in 68 CLBP patients aged 64 years and older. The CAS-D-65+ was analyzed performing an item analysis and retest reliability. For validation standardized assessment methods (Tampa Scale of Kinesiophobia [TSK], Photography of Daily Activity - Short electronic Version [Phoda-SeV], 5-Item-FAB, pain, disability, well-being and strain) were used. Internal consistency (Cronbach's α) ranged from 0.87 to 0.92 for total scale and from 0.71 to 0.89 for the sub-scales "catastrophizing" and "avoidance", retest reliability (r(tt)) ranged from 0.67 for the sub-scale "catastrophizing" to 0.70 for total scale and sub-scale "avoidance". The CAS-D-65+ showed moderate and strong effect sizes (Cohen's d) with other related FAB scales and external criteria. As shown in this study the CAS-D-65+ is a reliable and a valid instrument for the assessment of FAB in older patients with CLBP.

The association between fear of cancer recurrence and quality of life among Chinese cancer survivors: main effect hypothesis and buffering hypothesis.

PubMed

Cho, Dalnim; Lu, Qian

2017-09-01

The aim of the present study is to examine whether fear of cancer recurrence (FCR) is related to health-related quality of life (HRQOL) among Chinese cancer survivors, an understudied population (i.e., main effect hypothesis). Also, we investigated whether the FCR-HRQOL link is moderated by two coping strategies, avoidance and positive reappraisal (i.e., buffering hypothesis). This is a cross-sectional study conducted among 238 Chinese cancer survivors in Beijing. Participants completed a set of questionnaires including FCR, coping, and HRQOL. FCR was related to lower physical, psychological, social, and spiritual well-beings, even when demographics, cancer-related factors, and coping were taken into account. There was only one moderation effect between FCR and avoidance coping. Surprisingly, the detrimental effect of FCR on spiritual well-being was lessened among those with high avoidance coping such that the negative association between FCR and spiritual well-being was only found in those with low avoidance coping and not among those with high avoidance coping. Findings largely supported the main effect hypothesis. FCR was associated with diverse domains of HRQOL among Chinese cancer survivors. The buffering hypothesis was largely not supported in this population. Rather, in some cases, the effects of FCR and coping strategies on HRQOL were independent. Thus, ways to attenuate the harmful effects of FCR on HRQOL among Chinese cancer survivors remain unresolved. It is urgent and timely that future studies focus on FCR and HRQOL in this population.

Neural, psychophysiological, and behavioral markers of fear processing in PTSD: a review of the literature.

PubMed

Shvil, Erel; Rusch, Heather L; Sullivan, Gregory M; Neria, Yuval

2013-05-01

As presently defined, post-traumatic stress disorder (PTSD) is an amalgam of symptoms falling into: re-experiencing of the trauma, avoidance of reminders of it, emotional numbing and hyperarousal. PTSD has a well-known proximate cause, commonly occurring after a life-threatening event that induces a response of intense fear, horror, and helplessness. Much of the advancement in understanding of the neurobiology of PTSD has emerged from conceptualizing the disorder as one that involves substantial dysfunction in fear processing. This article reviews recent knowledge of fear processing markers in PTSD. A systematic search was performed of reports within the specific three-year publication time period of January 2010 to December 2012. We identified a total of 31 studies reporting fear processing markers in PTSD. We further categorized them according to the following classification: (1) neural-activation markers (n=10), (2) psychophysiological markers (n=14), and (3) behavioral markers (n=7). Across most studies reviewed here, significant differences between individuals with PTSD and healthy controls were shown. Methodological, theoretical and clinical implications were discussed.

Miasmatic calories and saturating fats: fear of contamination in anorexia.

PubMed

Warin, Megan

2003-03-01

This paper draws on ethnographic material to challenge the taken-for-granted relationship between anorexia and fear of fat. While popular understandings assume anorexia to be an extension of everyday dietary guidelines and a fear of weight gain from foods high in fats and calories, I argue that it is fear of contamination rather than fear of fat per se that is at issue. Through a critique and extension of Mary Douglas' structuralist typology and Julia Kristeva's embodied theory of abjection, I demonstrate that it is the qualities of certain foods, and in particular their amorphous natures, that render them contaminating. Saturating fats and invisible calories are considered dangerous by people with anorexia because they have the ability to move, seep, and infiltrate the body through the interplay of senses. Foods that transgress conceptual and bodily boundaries are thus to be avoided at all costs, for they have the potential to defile and pollute. In light of the low recovery rates for those with anorexia within Australia (and internationally), the findings of this paper have significant implications for the understanding and treatment of this disorder.

Investigating the Role of Interpersonal Sensitivity, Anger, and Perfectionism in Social Anxiety.

PubMed

Mohammadian, Youkhabeh; Mahaki, Behzad; Dehghani, Mahmoud; Vahid, Mohammadkazem Atef; Lavasani, Fahimeh Fathali

2018-01-01

The investigation of personality characteristics and emotional experiences of the people suffering from anxiety disorders is one of the most important issues which are considered by researchers and clinicians. Perfectionism, sensitivity to interpersonal rejection, and anger are personality traits related to social anxiety. In social anxiety disorder, it has also been focused on anger as a personality characteristic and as an emotional condition. The main purpose of this work is to investigate the role of these variables in predicting social anxiety among a nonclinical group of Iranian students. In this cross-sectional study, 131 students completed the self-report version of Liebowitz Social Anxiety Scale Self-Report version (LSAS-SR), Frost Multidimensional Perfectionism Scale (FMPS), Interpersonal Sensitivity Measure (IPSM), and State and Trait Anger Expression Inventory. Multiple linear regressions were conducted to examine the concurrent associations between perfectionism, interpersonal sensitivity and quality of emotional experience, and expression of anger with severity of self-report social anxiety. Greater levels of FMPS total were significantly associated with a greater level of LSAS total, fear, and avoidance of social and functional situations ( P = 0.022, P = 0.024, and P = 0.006). Moreover, a significant positive correlation between IPSM total ( P = 0.015) with fear and also between anger expression index ( P = 0.009) with avoidance subscale were found. In accordance to the previous researches, we found that perfectionism, interpersonal sensitivity, anger experience, and anger expression skills are related to social anxiety. How these personality traits are related to fear and avoidance of social situations and their concurrent effects on predicting social anxiety were discussed.

Initial validation of the Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS): A measure of three restrictive eating patterns.

PubMed

Zickgraf, Hana F; Ellis, Jordan M

2018-04-01

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating or feeding disorder characterized by inadequate nutritional or caloric intake leading to weight loss, nutritional deficiency, supplement dependence, and/or significant psychosocial impairment. DSM-5 lists three different eating patterns that can lead to symptoms of ARFID: avoidance of foods due to their sensory properties (e.g., picky eating), poor appetite or limited interest in eating, or fear of negative consequences from eating. Research on the prevalence and psychopathology of ARFID is limited by the lack of validated instruments to measure these eating behaviors. The present study describes the development and validation of the nine-item ARFID screen (NIAS), a brief multidimensional instrument to measure ARFID-associated eating behaviors. Participants were 455 adults recruited on Amazon's Mechanical Turk, 505 adults recruited from a nationally-representative subject pool, and 311 undergraduates participating in research for course credit. Exploratory and confirmatory factor analyses provided evidence for three factors. The NIAS subscales demonstrated high internal consistency, test-retest reliability, invariant item loadings between two samples, and convergent/discriminant validity with other measures of picky eating, appetite, fear of negative consequences, and psychopathology. The scales were also correlated with measures of ARFID-like symptoms (e.g., low BMI, low fruit/vegetable variety and intake, and eating-related psychosocial interference/distress), although the picky eating, appetite, and fear scales had distinct independent relationships with these constructs. The NIAS is a brief, reliable instrument that may be used to further investigate ARFID-related eating behaviors. Copyright © 2017 Elsevier Ltd. All rights reserved.

Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion.

PubMed

Louw, Adriaan; Puentedura, Emilio J; Reese, Dave; Parker, Paula; Miller, Terra; Mintken, Paul E

2017-10-01

To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain. Single-blind case series. Three outpatient physical therapy clinics. Patients with shoulder pain and limited AROM (N=69). Patients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder. We measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy. There were significant differences in self-reported pain (P=.014), pain catastrophization (P<.001), and the Tampa Scale of Kinesiophobia (P=.012) immediately after mirror therapy; however, the means did not meet or exceed the minimal detectable change (MDC) for each outcome measure. There was a significant increase (mean, 14.5°) in affected shoulder flexion AROM immediately postmirror therapy (P<.001), which exceeded the MDC of 8°. A brief mirror therapy intervention can result in statistically significant improvements in pain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer-term effects. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Keep Your Voice Sound: How to Prevent and Avoid Voice Problems

MedlinePlus

... ways, your voice is as unique as your fingerprint. It’s produced in your throat by 2 bands ... Act No Fear Act Office of Inspector General USA.gov – Government Made Easy NIH…Turning Discovery Into ...

An investigation into the psychobiology of social phobia: personality domains and serotonergic function.

PubMed

Chatterjee, S; Sunitha, T A; Velayudhan, A; Khanna, S

1997-06-01

The aim of the present study was to explore a psychobiological perspective in the aetiology of social phobia. The emphasis was on serotonergic function and personality. A total of 20 social phobics according to ICD-10 DCR criteria were assessed with the Schedule for Clinical Assessment in Neuropsychiatry and the International Personality Disorder Examination. They were compared with an age-matched normal population with regard to scores on the Fear of Negative Evaluation Scale, the Social Avoidance and Distress Scale, the Temperament and Character Inventory, and platelet 5HT2 receptor function. Other Axis-I disorders and cluster C personality disorders were frequently encountered. The social phobia group was characterized by high levels of harm avoidance, and low levels of novelty seeking, co-operativeness and self-directedness. Platelet 5HT2 receptor density did not differentiate between the groups, but was associated with severity of social phobia. An integrated psychobiological model is presented.

Decrease of fear avoidance beliefs following person-centered progressive resistance exercise contributes to reduced pain disability in women with fibromyalgia: secondary exploratory analyses from a randomized controlled trial.

PubMed

Palstam, Annie; Larsson, Anette; Löfgren, Monika; Ernberg, Malin; Bjersing, Jan; Bileviciute-Ljungar, Indre; Gerdle, Björn; Kosek, Eva; Mannerkorpi, Kaisa

2016-05-21

Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Women with FM also report disability, in terms of negative consequences on activities of daily living. Our recent randomized controlled trial (RCT) is the first study of resistance exercise to show positive effects on pain disability. The resistance exercise program of our RCT emphasized active involvement of participants in planning and progression of the exercise, using the principles of person-centeredness, to support each participant's ability to manage the exercise and the progress of it. The aim of this sub-study was to investigate explanatory factors for reduced pain disability in women with FM participating in a 15-week person-centered progressive resistance exercise program. A total of 67 women with FM were included in this sub-study of an RCT examining the effects of person-centered progressive resistance exercise performed twice a week for 15 weeks. Tests of physical capacity and health-related questionnaires were assessed at baseline and after the intervention period. Multivariable stepwise regression was used to analyze explanatory factors for improvements in pain disability. Reduced pain disability was explained by higher pain disability at baseline together with decreased fear avoidance beliefs about physical activity (R (2) = 28, p = 0.005). The improvements in the disability domains of recreation and social activity were explained by decreased fear avoidance beliefs about physical activity together with higher baseline values of each disability domain respectively (R (2) = 32, p = 0.025 and R (2) = 30, p = 0.017). The improvement in occupational disability was explained by higher baseline values of occupational disability (R (2) = 19, p = 0.001). The person-centered resistance exercise intervention, based on principles of self-efficacy, had a positive effect on recreational, social and occupational disability. The reduced pain disability seemed to be mediated by decreased fear avoidance beliefs. Age, symptom duration, pain intensity, and muscle strength at baseline had no explanatory value for reduced pain disability, indicating that the person-centered resistance exercise program has the potential to work for anyone with FM who has interest in physical exercise. The trial was registered on October 21, 2010 with ClinicalTrials.gov identification number: NCT01226784 .

Effect of a Matter of Balance programme on avoidance behaviour due to fear of falling in older adults.

PubMed

Sartor-Glittenberg, Cecelia; Bordenave, Elton; Bay, Curt; Bordenave, Lori; Alexander, Jeffrey L

2018-05-01

Fear of falling (FOF) is associated with restricted activities, increased risk of falling, and decreased quality of life. A Matter of Balance (AMOB) is an evidence-based programme designed to decrease FOF. The current study investigated the influence of the AMOB on activity avoidance caused by FOF in older adults using the Fear of Falling Avoidance Behavior Questionnaire (FFABQ), health-related quality of life, and a question regarding concerns about falling. Participants of this quasi-experimental, one-group, pretest-post-test study design were older adults from community sites in the Phoenix, Arizona, metropolitan area. Participants attended the AMOB programme, which consisted of one weekly 2-h session for 8 weeks. At the beginning and end of the programme, participants completed the standard AMOB assessments, the FFABQ, the Centers for Disease Control Core Healthy Days Measure (CDC HRQOL-4), and a question regarding concerns about falling. Sixty-three participants completed the study; their mean ± SD age was 75.3 ± 7.1 years (range: 60.0-90.0 years), and 84.1% were women. The FFABQ scores decreased from baseline (24.4 ± 12.7 points) to post-AMOB (20.1 ± 11.9 points; t = 2.62, P = 0.01). No changes in any of the CDC HRQOL-4 questions were noted (CDC HRQOL-4 question (Q)1 (z = -1.41, P = 0.16), CDC HRQOL-4 Q2 and Q3 summary index (z = -1.60, P = 0.11), and CDC HRQOL-4 Q4 (z = -0.97, P = 0.33)). Concerns about falling decreased from baseline (3.4 ± 0.9 points) to post-AMOB (2.8 ± 0.8 points; z = -4.09, P < 0.001). Avoidance behaviour caused by FOF, as measured by the FFABQ, and concerns about falling decreased in community-dwelling older adults who participated in the AMOB. Findings support the efficacy of the AMOB for reducing both avoidance behaviour caused by FOF and concerns about falling through an approach that combines education and exercise. © 2018 Japanese Psychogeriatric Society.

Chronic aerial exposure to glucorticoids or beta-agonists affects avoidance learning and exploratory motivation in rats.

PubMed

Elías, Pedro C; Sagua, Delia; Alvarez, Edgardo O

2004-02-04

The purpose of the present work was to examine if the conventional asthma treatments in humans (inhalation of glucocorticoids or beta-agonists, administered in a chronic regimen) might affect behavioral processes (learning and exploratory motivation) in rats. Adult male rats were exposed to an atmosphere saturated with either saline, budesonide (a glucocorticoid), or salbutamol (a beta-adrenergic receptor agonist) in a forced ventilation cage, connected to a nebulizer for 5 min twice a day for 15 days at the same hours of the day. Doses of budesonide in the nebulizing solution were 0.116, 1.16, and 11.6mM. Doses of salbutamol in the nebulizing solution were 1.3, 13, and 130 mM. Forty-eight hours after treatment, the different groups were subjected to exploration of an elevated asymmetric plus-maze (APM, model of exploratory motivation), and 24h later to learning of an avoidance response to an ultrasonic tone in a two-compartment cage (model of memory and learning). Results showed that budesonide induces moderate effects on exploratory motivation. In one of the fear-inducing arms (single wall arm), exploration decreased and this effect was not dose dependent. In the cognitive model, glucocorticoids affected slightly the latency to escape but with no interference in memory efficiency. On the other hand, at the lower dose in the APM, salbutamol increased significantly the exploration of both fear-inducing arms (no walls and single wall arms). In the learning model, the beta-agonist induced two opposing effects. The lower dose (1.3mM) facilitated learning and the higher dose (13 mM) inhibited learning instead. In conclusion, results are compatible with the notion that inhaled glucocorticoids or beta-agonists might cross the lung aerial barrier into the blood compartment, exerting effects on learning and motivation functions.

Prospective Investigation of the Contrast Avoidance Model of Generalized Anxiety and Worry.

PubMed

Crouch, Tara A; Lewis, Jamie A; Erickson, Thane M; Newman, Michelle G

2017-07-01

The factors that maintain generalized anxiety disorder (GAD) symptoms and worry over time are not entirely clear. The Contrast Avoidance Model (CAM) postulates that individuals at risk for pathological worry and GAD symptoms uniquely fear emotional shifts from neutral or positive emotions into negative emotional states, and consequently use worry to maintain negative emotion in order to avoid shifts or blunt the effect of negative contrasts. This model has received support in laboratory experiments, but has not been investigated prospectively in the naturalistic context of daily life. The present study tested the CAM in a longitudinal experience sampling study with a subclinical sample. Participants selected to represent a broad range of symptoms (N = 92) completed baseline measures of GAD and depression symptoms, and eight weekly assessments of worry, experiences of negative emotional contrasts during their worst event of the week, and situation-specific negative emotion. Consistent with the CAM, GAD symptoms prospectively predicted higher endorsement of negative contrast experiences as worst events, independent of depression symptoms. Unsurprisingly, higher negative contrasts predicted higher negative emotion. However, both higher baseline GAD symptoms and weekly worry uniquely moderated (reduced) this relationship, providing consistent support for the idea that worry may blunt the emotional effects of contrasts. Depression symptoms did not have the same moderating effect. These findings support the CAM in an ecologically valid context. Copyright © 2016. Published by Elsevier Ltd.

Immunization with a heat-killed preparation of the environmental bacterium Mycobacterium vaccae promotes stress resilience in mice

PubMed Central

Reber, Stefan O.; Siebler, Philip H.; Donner, Nina C.; Morton, James T.; Smith, David G.; Kopelman, Jared M.; Lowe, Kenneth R.; Wheeler, Kristen J.; Fox, James H.; Hassell, James E.; Greenwood, Benjamin N.; Jansch, Charline; Lechner, Anja; Schmidt, Dominic; Uschold-Schmidt, Nicole; Füchsl, Andrea M.; Langgartner, Dominik; Walker, Frederick R.; Hale, Matthew W.; Lopez Perez, Gerardo; Van Treuren, Will; González, Antonio; Halweg-Edwards, Andrea L.; Fleshner, Monika; Raison, Charles L.; Rook, Graham A.; Peddada, Shyamal D.; Knight, Rob

2016-01-01

The prevalence of inflammatory diseases is increasing in modern urban societies. Inflammation increases risk of stress-related pathology; consequently, immunoregulatory or antiinflammatory approaches may protect against negative stress-related outcomes. We show that stress disrupts the homeostatic relationship between the microbiota and the host, resulting in exaggerated inflammation. Repeated immunization with a heat-killed preparation of Mycobacterium vaccae, an immunoregulatory environmental microorganism, reduced subordinate, flight, and avoiding behavioral responses to a dominant aggressor in a murine model of chronic psychosocial stress when tested 1–2 wk following the final immunization. Furthermore, immunization with M. vaccae prevented stress-induced spontaneous colitis and, in stressed mice, induced anxiolytic or fear-reducing effects as measured on the elevated plus-maze, despite stress-induced gut microbiota changes characteristic of gut infection and colitis. Immunization with M. vaccae also prevented stress-induced aggravation of colitis in a model of inflammatory bowel disease. Depletion of regulatory T cells negated protective effects of immunization with M. vaccae on stress-induced colitis and anxiety-like or fear behaviors. These data provide a framework for developing microbiome- and immunoregulation-based strategies for prevention of stress-related pathologies. PMID:27185913

Development of fear and guilt in young children: stability over time and relations with psychopathology.

PubMed

Baker, Erika; Baibazarova, Eugenia; Ktistaki, Georgia; Shelton, Katherine H; van Goozen, Stephanie H M

2012-08-01

Extremes in fearful temperament have long been associated with later psychopathology and risk pathways. Whereas fearful children are inhibited and anxious and avoid novel events, fearless individuals are disinhibited and more likely to engage in aggressive behavior. However, very few studies have examined fear in infants from a multimethod and prospective longitudinal perspective. This study had the following objectives: to examine behavioral, maternal reported, and physiological indices of fearful temperament in infancy, together with their relations and stability over time; and to establish whether early indices of fear predict fear later in toddlerhood. We also examined the association between behavioral and physiological measures of fear and guilt and whether fear in infancy predicts guilt in toddlers. Finally, we investigated infant risk factors for later psychopathology. We recorded skin conductance level (SCL) and heart rate (HR) and observed children's responses during a Laboratory Temperament Assessment Battery fear paradigm across the first 3 years of life and during a guilt induction procedure at age 3 (N = 70). The results indicate that different measures of infant fear were associated across time. Observed fearlessness in infancy predicted observed fearlessness and low levels of SCL arousal to fear and guilt in toddlers. Low levels of HR and SCL to fear in infancy predicted low levels of physiological arousal to the same situation and to guilt 2 years later. Fear and guilt were significantly associated across measures. Finally, toddlers with clinically significant internalizing problems at age 3 were already notably more fearful in Year 1 as reflected by their significantly higher HR levels. The results indicated that assessments of children in infancy are predictive of how these children react 2 years later and therefore lend support to the idea that the emotional thermostat is set in the first 3 years of life. They also showed, for the first time, that infant fear is a predictor of guilt, which is an emotion that develops later. The implications of these findings for our understanding of developmental psychopathology are discussed.

Psychological but not vasomotor symptoms are associated with temperament and character traits.

PubMed

Kokras, N; Papadopoulos, L; Zervas, I M; Spyropoulou, A; Stamatelopoulos, K; Rizos, D; Creatsa, M; Augoulea, A; Papadimitriou, G N; Lambrinoudaki, I

2014-08-01

Recent evidence suggests that climacteric symptoms may be intensified by specific temperament and personality traits in postmenopausal women. In this study we investigate Cloninger's model of personality in relation to menopausal symptoms. One-hundred and seventy peri- and postmenopausal women consecutively recruited from a menopause clinic of an academic hospital completed the Cloninger's Temperament and Character Inventory (TCI-140) which measures four dimensions of temperament: Harm avoidance, Novelty seeking, Reward dependence and Persistence, as well as three dimensions of character: Self-directedness, Cooperativeness, and Self-transcendence. Menopausal somatic, vasomotor and psychological symptoms were also assessed using the Greene Climacteric Scale. In comparison to the norms of the Greek general population, postmenopausal women presented lower scores in Novelty seeking and Reward dependence and higher scores in Persistence, Self-directedness, Cooperativeness and Self-transcendence. Higher harm avoidance (the inclination to avoid potential punishment, be shy and fearful of uncertainty) significantly correlated with anxiety and depressive symptoms while lower Self-directedness (the ability to have the willpower to adapt to or overcome any changes) correlated with depressive symptoms only. By multivariate regression analysis, higher Harm avoidance and lower Self-directedness were independently associated with the presence of depressive symptoms. No significant associations were observed between TCI-140 traits and somatic or vasomotor symptoms. Our findings indicate that most temperament and character traits according to Cloninger's model in peri- and postmenopausal women varied significantly as compared to the general population. Among several traits, high Harm avoidance and low Self-directedness were most strongly associated with psychological climacteric distress but not with somatic and vasomotor symptoms.

Early ERP Modulation for Task-Irrelevant Subliminal Faces.

PubMed

Pegna, Alan J; Darque, Alexandra; Berrut, Claire; Khateb, Asaid

2011-01-01

A number of investigations have reported that emotional faces can be processed subliminally, and that they give rise to specific patterns of brain activation in the absence of awareness. Recent event-related potential (ERP) studies have suggested that electrophysiological differences occur early in time (<200 ms) in response to backward-masked emotional faces. These findings have been taken as evidence of a rapid non-conscious pathway, which would allow threatening stimuli to be processed rapidly and subsequently allow appropriate avoidance action to be taken. However, for this to be the case, subliminal processing should arise even if the threatening stimulus is not attended. This point has in fact not yet been clearly established. In this ERP study, we investigated whether subliminal processing of fearful faces occurs outside the focus of attention. Fourteen healthy participants performed a line judgment task while fearful and non-fearful (happy or neutral) faces were presented both subliminally and supraliminally. ERPs were compared across the four experimental conditions (i.e., subliminal and supraliminal; fearful and non-fearful). The earliest differences between fearful and non-fearful faces appeared as an enhanced posterior negativity for the former at 170 ms (the N170 component) over right temporo-occipital electrodes. This difference was observed for both subliminal (p < 0.05) and supraliminal presentations (p < 0.01). Our results confirm that subliminal processing of fearful faces occurs early in the course of visual processing, and more importantly, that this arises even when the subject's attention is engaged in an incidental task.

Associations among fear, disgust, and eating pathology in undergraduate men and women.

PubMed

Anderson, Lisa M; Reilly, Erin E; Thomas, Jennifer J; Eddy, Kamryn T; Franko, Debra L; Hormes, Julia M; Anderson, Drew A

2018-06-01

Fear and disgust are distinct emotions that have been independently linked with EDs and may motivate avoidance behaviors that may be relevant targets for ED interventions (e.g., food rejection). Despite similar motivational function, it is possible that one emotion is more strongly associated with ED symptoms, relative to the other. Given that emerging evidence suggests that disgust-based behavior may be more difficult to change than fear-based behaviors, research is needed to evaluate whether each emotion differentially relates to ED symptoms. Therefore, the current study tested the relative importance of fear and disgust in accounting for variance in ED symptoms. Participants included undergraduate men (n = 127) and women (n = 263) from a university in the northeast US. Participants completed self-report measures assessing demographics, disordered eating attitudes and behaviors, and visual analog scales assessing fear and disgust responses to high-calorie food images, low-calorie food images, and non-food fear and disgust images. Bivariate correlations revealed significant positive associations among fear, disgust, and EDE-Q global symptom scores. Relative weights analysis results yielded relative importance weights that suggested disgust responding to high calorie food images accounts for the greatest total variance in EDE-Q global symptom scores in men, and fear responding to high calorie food images accounts for the greatest total variance in EDE-Q scores in women. Findings provide initial evidence that investigative and clinical efforts should consider fear and disgust as unique facets of negative affect with different patterns of relative importance to ED symptoms in undergraduate men and women. Copyright © 2018 Elsevier Ltd. All rights reserved.

The role of fear of movement in subacute whiplash-associated disorders grades I and II.

PubMed

Robinson, James P; Theodore, Brian R; Dansie, Elizabeth J; Wilson, Hilary D; Turk, Dennis C

2013-03-01

Fear and avoidance of activity may play a role in fostering disability in whiplash-associated disorders (WAD). This study examined the role of fear after WAD and assessed the effectiveness of 3 treatments targeting fear. People still symptomatic from WAD grade I-II injuries approximately 3months previously (n=191) completed questionnaires (eg, Neck Disability Index [NDI]) and were randomized to 1 of the treatments: (1) informational booklet (IB) describing WAD and the importance of resuming activities, (2) IB+didactic discussions (DD) with clinicians reinforcing the booklet, and (3) IB+imaginal and direct exposure desensitization (ET) to feared activities. DD and ET participants received three 2-hour treatment sessions. Absolute improvements in NDI were in predicted direction (ET=14.7, DD=11.9, IB=9.9). ETs reported significantly less posttreatment pain severity compared with the IB (Mean=1.5 vs 2.3, P<.001, d=0.6) and DD (M=1.5 vs 2.0, P=.039, d=0.6) groups. Reduction in fear was the most important predictor of improvement in NDI (β=0.30, P<.001), followed by reductions in pain (β=0.20, P=.003) and depression (β=0.18, P=.004). The mediational analysis confirmed that fear reduction significantly mediated the effect of treatment group on outcome. Results highlight the importance of fear in individuals with subacute WAD and suggest the importance of addressing fear via exposure therapy and/or educational interventions to improve function. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

An Abrupt Transformation of Phobic Behavior After a Post-Retrieval Amnesic Agent.

PubMed

Soeter, Marieke; Kindt, Merel

2015-12-15

Although disrupting the process of memory reconsolidation has a great potential for clinical practice, the fear-amnesic effects are typically demonstrated through Pavlovian conditioning. Given that older and stronger memories are generally more resistant to change, we tested whether disrupting reconsolidation would also diminish fear in individuals who had developed a persistent spider fear outside the laboratory. Spider-fearful participants received a single dose of 40 mg of the noradrenergic β-blocker propranolol (n = 15), double-blind and placebo-controlled (n = 15), after a short 2-min exposure to a tarantula. To test whether memory reactivation was necessary to observe a fear-reducing effect, one additional group of spider-fearful participants (n = 15) received a single dose of 40 mg propranolol without memory reactivation. Disrupting reconsolidation of fear memory transformed avoidance behavior into approach behavior in a virtual binary fashion-an effect that persisted at least 1 year after treatment. Interestingly the β-adrenergic drug did initially not affect the self-declared fear of spiders but instead these reports followed the instant behavioral transformation several months later. Our findings are in sharp contrast with the currently pharmacological and cognitive behavioral treatments for anxiety and related disorders. The β-adrenergic blocker was only effective when the drug was administered upon memory reactivation, and a modification in cognitive representations was not necessary to observe a change in fear behavior. A new wave of treatments that pharmacologically target the synaptic plasticity underlying learning and memory seems to be within reach. Copyright © 2015 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Is eye to eye contact really threatening and avoided in social anxiety?--An eye-tracking and psychophysiology study.

PubMed

Wieser, Matthias J; Pauli, Paul; Alpers, Georg W; Mühlberger, Andreas

2009-01-01

The effects of direct and averted gaze on autonomic arousal and gaze behavior in social anxiety were investigated using a new paradigm including animated movie stimuli and eye-tracking methodology. While high, medium, and low socially anxious (HSA vs. MSA vs. LSA) women watched animated movie clips, in which faces responded to the gaze of the participants with either direct or averted gaze, their eye movements, heart rate (HR) and skin conductance responses (SCR) were continuously recorded. Groups did not differ in their gaze behavior concerning direct vs. averted gaze, but high socially anxious women tended to fixate the eye region of the presented face longer than MSA and LSA, respectively. Furthermore, they responded to direct gaze with more pronounced cardiac acceleration. This physiological finding indicates that direct gaze may be a fear-relevant feature for socially anxious individuals in social interaction. However, this seems not to result in gaze avoidance. Future studies should examine the role of gaze direction and its interaction with facial expressions in social anxiety and its consequences for avoidance behavior and fear responses. Additionally, further research is needed to clarify the role of gaze perception in social anxiety.

Steroid fears in children with eczema.

PubMed

Hon, Kam-Lun Ellis; Kam, Wai-Yan Christy; Leung, Ting-Fan; Lam, Man-Ching Adrian; Wong, Kin-Yee; Lee, Kwing-Chin Kenneth; Luk, Nai-Ming Tommy; Fok, Tai-Fai; Ng, Pak-Cheung

2006-11-01

Topical glucocorticoids (GCs) are the mainstay of treatment for eczema, but GC phobia and fears are very common among the parents of paediatric patients. To survey the nature and extent of "fears" of GC use, and to evaluate if disease severity is associated with such fears. Patients with eczema managed in the paediatric dermatology outpatient clinic of a university hospital were recruited in this survey. Disease severity and various aspects of belief and practices of GC use were assessed with the Nottingham Eczema Severity Score and a questionnaire. GC "fears" were present in two fifths of informants with non-eczematous skin disease and mild eczema, but three fifths in moderate-to-severe disease. Requests for steroid-sparing medications (such as tacrolimus or pimecrolimus) had been made in nearly 50% of cases with moderate-to-severe eczema, and many parents would wait until eczema had worsened or apply GC only as a last resort to avoid potential side effects. "Fears" were predominantly interpersonal and rarely iatrogenic in nature. Skin problems (in particular skin thinning) and adverse effects on growth were the side effects of GC of most concern. However, fewer than half of the informants had discussed their concerns with doctors. Our results suggest the importance of understanding the nature and extent to which GC fears, regardless of eczema severity, are prevalent so that sound advice can be offered in a timely manner to parents and patients.

Fear, Sadness and Hope: Which Emotions Maximize Impact of Anti-Tobacco Mass Media Advertisements among Lower and Higher SES Groups?

PubMed

Durkin, Sarah; Bayly, Megan; Brennan, Emily; Biener, Lois; Wakefield, Melanie

2018-01-01

Emotive anti-tobacco advertisements can increase quitting. Discrete emotion theories suggest evoking fear may be more effective than sadness; less research has focused on hope. A weekly cross-sectional survey of smokers and recent quitters (N = 7683) measured past-month quit attempts. The main predictor was level of exposure to four different types of anti-tobacco advertisements broadcast in the two months prior to quit attempts: advertisements predominantly evoking fear, sadness, hope, or evoking multiple negative emotions (i.e., fear, guilt, and/or sadness). Greater exposure to fear-evoking advertisements (OR = 2.16, p < .01) increased odds of making a quit attempt and showed similar effectiveness among those in lower and higher SES areas. Greater exposure to advertisements evoking multiple negative emotions increased quit attempts (OR = 1.70, p < .01), but interactions indicated this was driven by those in lower SES, but not higher SES areas. Greater exposure to hope-evoking advertisements enhanced effects of fear-evoking advertisements among those in higher SES, but not lower SES areas. Findings suggest to be maximally effective across the whole population avoid messages evoking sadness and use messages eliciting fear. If the aim is to specifically motivate those living in lower SES areas where smoking rates are higher, multiple negative emotion messages, but not hope-evoking messages, may also be effective.

What dental phobics say about their dental experiences.

PubMed

Liddell, A; Ackerman, C; Locker, D

1990-09-01

Previous surveys have indicated that there is a substantial proportion of dentally anxious individuals in the general population. Many of these individuals avoid contact with dentistry as much as possible, while fearful individuals who present themselves for treatment are probably too uncomfortable or too afraid to make their views known. Consequently, a study of the feelings and attitudes of a group of dental phobics was carried out as part of a larger study of the efficacy of psychological treatments for excessive dental anxiety. The subjects were recruited by means of a newspaper advertisement and asked to complete a questionnaire designed to obtain information regarding their dental experiences and attitudes. Twenty-three individuals provided enough data for analysis. They were distributed widely in terms of age, education, income levels, and general fearfulness. They reported less satisfaction with the level of understanding or acceptance found in the last dentist they had seen than with the dentist's level of technical competence and the diagnostic information they received. Dental phobics who had been to a dentist in the past year were generally more satisfied with their dentist than those who had not. It is suggested that a good dentist-patient relationship based on understanding and acceptance is an important factor in overcoming the avoidance of fearful patients.

What are the Effects of Protest Fear?

DTIC Science & Technology

2014-06-01

Program AT&L Acquisition, Technology, and Logistics BPA blanket purchase agreement CONUS continental United States COR...they have awarded a task/delivery order against an IDIQ contract (or Blanket Purchase Agreement [ BPA ]) in order to avoid a bid protest. The data shows

Adult attachment and approaches to activity engagement in chronic pain

PubMed Central

Andrews, Nicole E; Meredith, Pamela J; Strong, Jenny; Donohue, Genevieve F

2014-01-01

BACKGROUND: The way in which individuals with chronic pain habitually approach activity engagement has been shown to impact daily functioning, with both avoidance of one’s daily activities and overactivity (activity engagement that significantly exacerbates pain) associated with more pain, higher levels of physical disability and poorer psychological functioning. OBJECTIVE: To provide insight into the development of maladaptive habitual approaches to activity engagement in chronic pain by applying an attachment theory framework. METHODS: A sample of 164 adults with chronic pain completed selfreport measures of attachment, approach to activity and pain cognitions. Mediation analyses were undertaken to examine the direct association between attachment variables and maladaptive approaches to activity, and to test for the mediating role of pain cognitions (catastrophizing and thought suppression). RESULTS: Results demonstrated that higher levels of secure attachment were associated with lower levels of activity avoidance, which was fully mediated by lower levels of pain catastrophizing; higher levels of preoccupied or fearful attachment were directly associated with higher levels overactivity; higher levels of preoccupied attachment were associated with higher levels of activity avoidance, which was partially mediated by higher levels of pain catastrophizing; and higher levels of fearful attachment were indirectly associated with higher levels of activity avoidance through higher levels of catastrophizing. CONCLUSIONS: These results provide preliminary support for the suggestion that insecure attachment may be a source of vulnerability to the development of disabling activity patterns in chronic pain. PMID:25337857

Cognitive Processing of Fear-Arousing Message Content.

ERIC Educational Resources Information Center

Hale, Jerold L.; And Others

1995-01-01

Investigates two models (the Elaboration Likelihood Model and the Heuristic-Systematic Model) of the cognitive processing of fear-arousing messages in undergraduate students. Finds in three of the four conditions (low fear, high fear, high trait anxiety) that cognitive processing appears to be antagonistic. Finds some evidence of concurrent…

Neonatal handling enduringly decreases anxiety and stress responses and reduces hippocampus and amygdala volume in a genetic model of differential anxiety: Behavioral-volumetric associations in the Roman rat strains.

PubMed

Río-Álamos, Cristóbal; Oliveras, Ignasi; Piludu, Maria Antonietta; Gerbolés, Cristina; Cañete, Toni; Blázquez, Gloria; Lope-Piedrafita, Silvia; Martínez-Membrives, Esther; Torrubia, Rafael; Tobeña, Adolf; Fernández-Teruel, Alberto

2017-02-01

The hippocampus and amygdala have been proposed as key neural structures related to anxiety. A more active hippocampus/amygdala system has been related to greater anxious responses in situations involving conflict/novelty. The Roman Low- (RLA) and High-avoidance (RHA) rat lines/strains constitute a genetic model of differential anxiety. Relative to RHA rats, RLA rats exhibit enhanced anxiety/fearfulness, augmented hippocampal/amygdala c-Fos expression following exposure to novelty/conflict, increased hippocampal neuronal density and higher endocrine responses to stress. Neonatal handling (NH) is an environmental treatment with long-lasting anxiety/stress-reducing effects in rodents. Since hippocampus and amygdala volume are supposed to be related to anxiety/fear, we hypothesized a greater volume of both areas in RLA than in RHA rats, as well as that NH treatment would reduce anxiety and the volume of both structures, in particular in the RLA strain. Adult untreated and NH-treated RHA and RLA rats were tested for anxiety, sensorimotor gating (PPI), stress-induced corticosterone and prolactin responses, two-way active avoidance acquisition and in vivo 7 T 1H-Magnetic resonance image. As expected, untreated RLA rats showed higher anxiety and post-stress hormone responses, as well as greater hippocampus and amygdala volumes than untreated RHA rats. NH decreased anxiety/stress responses, especially in RLA rats, and significantly reduced hippocampus and amygdala volumes in this strain. Dorsal striatum volume was not different between the strains nor it was affected by NH. Finally, there were positive associations (as shown by correlations, factor analysis and multiple regression) between anxiety and PPI and hippocampus/amygdala volumes. Copyright © 2016 Elsevier B.V. and ECNP. All rights reserved.

Comparison Between Chronic Migraine and Temporomandibular Disorders in Pain-Related Disability and Fear-Avoidance Behaviors.

PubMed

Gil-Martínez, Alfonso; Navarro-Fernández, Gonzalo; Mangas-Guijarro, María Ángeles; Lara-Lara, Manuel; López-López, Almudena; Fernández-Carnero, Josué; La Touche, Roy

2017-11-01

To compare patients with chronic migraine (CM) and chronic temporomandibular disorders (TMD) on disability, pain, and fear avoidance factors and to associate these variables within groups. Descriptive, cross-sectional study. A neurology department and a temporomandibular disorders consult in a tertiary care center. A total of 50 patients with CM and 51 patients with chronic TMD, classified by international criteria classifications. The variables evaluated included pain intensity (visual analog scale [VAS]), neck disability (NDI), craniofacial pain and disability (CF-PDI), headache impact (HIT-6), pain catastrophizing (PCS), and kinesiophobia (TSK-11). Statistically significant differences were found between the CM group and the chronic TMD group in CF-PDI (P < 0.001), PCS (P = 0.03), and HIT-6 (P < 0.001); however, there were no differences between the CM group and the VAS, NDI, and TSK-11 groups (P > 0.05). For the chronic TMD group, the combination of NDI and TSK-11 was a significant covariate model of CF-PDI (adjusted R2 = 0.34). In the CM group, the regression model showed that NDI was a significant predictive factor for HIT-6 (adjusted R2 = 0.19). Differences between the CM group and the chronic TMD group were found in craniofacial pain and disability, pain catastrophizing, and headache impact, but they were similar for pain intensity, neck disability, and kinesiophobia. Neck disability and kinesiophobia were covariates of craniofacial pain and disability (34% of variance) for chronic TMD. In the CM group, neck disability was a predictive factor for headache impact (19.3% of variance). © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Anxiety Sensitivity Physical and Cognitive Concerns in Relation to Smoking-oriented Cognition: An Examination Among Treatment-seeking Adults Who Smoke.

PubMed

Langdon, Kirsten J; Bakhshaie, Jafar; Lopez, Alicia; Tavakoli, Niloofar; Garey, Lorra; Raines, Amanda M; Kauffman, Brooke Y; Schmidt, Norman B; Zvolensky, Michael J

Elevated levels of anxiety sensitivity (AS; fear of anxiety and internal sensations) is highly common among adults who smoke, and contributes to several maladaptive smoking beliefs and behaviors. AS is comprised of 3 empirically established factors, relating to fears of social concerns, fears of physical symptoms, and fears of cognitive dyscontrol. Relatively few studies have examined how these 3 subscales pertain to smoking processes. The aim of the present investigation was to examine, among treatment-seeking adults who smoke, the interactive effects of AS-physical and cognitive concerns in relation to: perceived barriers to smoking cessation; smoking-related negative reinforcement expectancies; and smoking-related avoidance and inflexibility. Participants included 470 adults who smoke (47.8% female; mean age 37.2, SD 13.5), who were recruited to participate in a smoking-cessation treatment study. At the baseline assessment, participants completed self-report measures, including the Anxiety Sensitivity Index-3, Barriers to Cessation Scale, Smoking Consequences Questionnaire, and Avoidance and Inflexibility Scale. Results indicated that after controlling for the effects of sex, cigarette dependence, alcohol problems, tobacco-related medical illness, current axis 1 disorder, and AS-social concerns, a significant interaction emerged, such that the association between AS-cognitive concerns and the studied smoking-based cognitions were stronger among lower levels of AS-physical concerns (but not higher physical concerns). The current findings suggest that it may be beneficial to provide specialized smoking-cessation interventions for certain subgroups of adults who smoke, such as those with different AS profiles, to promote healthier beliefs about quitting.

Caffeine impairs the acquisition and retention, but not the consolidation of Pavlovian conditioned freezing in mice

PubMed Central

Dubroqua, Sylvain; Low, Samuel R.L.; Yee, Benjamin K.; Singer, Philipp

2014-01-01

Rationale The psychoactive substance, caffeine may improve cognitive performance, but its direct impact on learning and memory remains ill-defined. Conflicting reports suggest that caffeine may impair as well as enhance Pavlovian fear conditioning in animals, and its effect may vary across different phases of learning. Objectives To dissect the effect of a motor-stimulant dose of caffeine (30 mg/kg i.p.) on acquisition, retrieval or consolidation of conditioned fear in C57BL/6 mice. Methods Fear conditioning was evaluated in a conditioned freezing paradigm comprising 3 tone-shock pairings and a two-way active avoidance paradigm lasting two consecutive days with 80 conditioning trials per test session. Results Conditioning to both the discrete tone conditioned stimulus (CS) and the context was markedly impaired by caffeine. The deficits were similarly evident when caffeine was administered prior to acquisition or retrieval (48 and 72 h after conditioning); and the most severe impairment was seen in animals given caffeine before acquisition and before retrieval. A comparable deficit was observed in the conditioned active avoidance test. By contrast, caffeine administered immediately following acquisition neither affected the expression of tone freezing nor context freezing. Conclusions The present study challenges the previous report that caffeine primarily disrupts hippocampus-dependent conditioning to the context. At the relevant dose range, acute caffeine likely exerts more widespread impacts beyond the hippocampus, including amygdala and striatum that are anatomically connected to the hippocampus; and together they support the acquisition and retention of fear memories to discrete stimuli as well as diffused contextual cues. PMID:25172668

Effect of Vicarious Fear Learning on Children’s Heart Rate Responses and Attentional Bias for Novel Animals

PubMed Central

2014-01-01

Research with children has shown that vicarious learning can result in changes to 2 of Lang’s (1968) 3 anxiety response systems: subjective report and behavioral avoidance. The current study extended this research by exploring the effect of vicarious learning on physiological responses (Lang’s final response system) and attentional bias. The study used Askew and Field’s (2007) vicarious learning procedure and demonstrated fear-related increases in children’s cognitive, behavioral, and physiological responses. Cognitive and behavioral changes were retested 1 week and 1 month later, and remained elevated. In addition, a visual search task demonstrated that fear-related vicarious learning creates an attentional bias for novel animals, which is moderated by increases in fear beliefs during learning. The findings demonstrate that vicarious learning leads to lasting changes in all 3 of Lang’s anxiety response systems and is sufficient to create attentional bias to threat in children. PMID:25151521

Why Are People Afraid of the Dentist? Observations and Explanations

PubMed Central

Beaton, Laura; Freeman, Ruth; Humphris, Gerry

2014-01-01

Objective The aim of this review was to explore the peer-reviewed literature to answer the question: ‘Why are people afraid of the dentist?’ Method Relevant literature was identified by searching the following on-line databases: PubMed, PsycInfo, the Cochrane Library and Google Scholar. Publications were extracted if they explored the causes and consequences of dental fear, dental anxiety or dental phobia. Results The research evidence suggests that the causes of dental fear, dental anxiety or dental phobia are related to exogenous factors such as direct learning from traumatic experiences, vicarious learning through significant others and the media, and endogenous factors such as inheritance and personality traits. Each individual aetiological factor is supported by the evidence provided. Conclusions The evidence suggests that the aetiology of dental fear, anxiety or phobia is complex and multifactorial. The findings show that there are clear practical implications indicated by the existing research in this area: a better understanding of dental fear, anxiety and phobia may prevent treatment avoidance. PMID:24356305

Fear of falling as seen in the Multidisciplinary falls consultation.

PubMed

Gaxatte, C; Nguyen, T; Chourabi, F; Salleron, J; Pardessus, V; Delabrière, I; Thévenon, A; Puisieux, F

2011-06-01

Fear of falling may be as debilitating as the fall itself, leading to a restriction in activities and even a loss of autonomy. The main objective was to evaluate the prevalence of the fear of falling among elderly fallers. The secondary objectives were to determine the factors associated with the fear of falling and evaluate the impact of this fear on the activity "getting out of the house". Prospective study conducted between 1995 and 2006 in which fallers and patients at high risk for falling were seen at baseline by the multidisciplinary falls consultation team (including a geriatrician, a neurologist and a physical medicine and rehabilitation physician) and then, again 6 month later, by the same geriatrician. The fear of falling was evaluated with a yes/no question: "are you afraid of falling?". Out of 635 patients with a mean age of 80.6 years, 502 patients (78%) expressed a fear of falling. Patients with fear of falling were not older than those who did not report this fear, but the former were mostly women (P<0,001), who experienced more falls in the 6 months preceding the consultation (P=0.01), reported more frequently a long period of time spent on the floor after a fall (P<0.001), had more balance disorders (P=0.002) and finally, were using more frequently a walking technical aid (P=0.02). Patients with fear of falling were not going out alone as much as the fearless group (31% vs 53%, P<0.0001). Eighty-two percent of patients in the fearful group admitted to avoiding going out because they were afraid of falling. The strong prevalence of the fear of falling observed in this population and its consequences in terms of restricted activities justifies systematically screening for it in fallers or patients at risk for falling. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Low back pain beliefs are associated to age, location of work, education and pain-related disability in Chinese healthcare professionals working in China: a cross sectional survey.

PubMed

Tan, B-K; Smith, Anne J; O'Sullivan, Peter B; Chen, Gang; Burnett, Angus F; Briggs, Andrew M

2014-07-28

Low back pain (LBP) is the leading cause of disability worldwide. Evidence pointing towards a more efficacious model of care using a biopsychosocial approach for LBP management highlights the need to understand the pain-related beliefs of patients and those who treat them. The beliefs held by healthcare professionals (HCPs) are known to influence the treatment advice given to patients and consequently management outcomes. Back pain beliefs are known to be influenced by factors such as culture, education, health literacy, place of work, personal experience of LBP and the sequelae of LBP such as disability. There is currently a knowledge gap among these relationships in non-western countries. The aim of this study was to examine the associations between LBP-related beliefs among Chinese HCPs and characteristics of these HCPs. A convenience sample of 432 HCPs working in various health settings in Shanghai, China, completed a series of questionnaires assessing their demographic characteristics, LBP status, pain-related disability and their beliefs about their own LBP experience, using the Back beliefs Questionnaire (BBQ) and the Fear Avoidance Beliefs Questionnaire (FABQ). Younger Chinese HCPs (20-29 years) held more negative beliefs and attitudes related to LBP compared to older HCPs (>40years; BBQ mean difference [95% CI]: 2.4 [0.9 - 3.9], p = 0.001). HCPs working outside tertiary hospitals had poorer beliefs concerning the inevitable consequences of LBP (BBQ mean difference [95% CI]: -2.4 [-3.8 - -1.0], p = 0.001). HCPs who experienced LBP had higher level of fear avoidance beliefs when experiencing high LBP-related disability (FABQ-physical mean difference [95% CI]: 2.8 [1.5 - 4.1], p < 0.001; FABQ-work mean difference [95% CI]: 6.2 [4.0 - 8.4], p < 0.001)) and had lower level of fear avoidance beliefs if they had completed postgraduate study (FABQ-physical mean difference [95% CI]: 2.9 [-5.8 - 0.0], p = 0.049). This study suggests that LBP-related beliefs and attitudes among Chinese HCPs are influenced by age, location of work, level of LBP-related disability and education level. Understanding back pain beliefs of Chinese HCPs forms an important foundation for future studies into the condition and its management in China.

'Living within your limits': activity restriction in older people experiencing chronic pain.

PubMed

Mackichan, Fiona; Adamson, Joy; Gooberman-Hill, Rachael

2013-11-01

although maintaining activity is key to successful pain management, and important to health and wellbeing, it is known that older people in pain frequently alter or reduce activity levels. A 'fear-avoidance' model is often used to explain avoidance of activity in the face of pain. However, this model is not intended to take account of the wider context in which activity changes take place, nor older people's own explanations for their behaviour. to investigate the reasons why older people in the community adjust their activity levels when living with chronic pain. thirty-one people aged between 67 and 92 were purposively sampled from respondents to a community-based cross-sectional survey. All participants had reported long-term pain and were interviewed about this. Data were collected and analysed using a qualitative constructivist grounded theory approach. explanations for deliberative reduction or ceasing of activities reflected a desire to prevent pain exacerbation, thereby avoiding medical intervention. It also reflected a desire to safeguard autonomy in the face of pain in older age. Restrictions were often rationalised as normal in older age, although co-existing accounts of perseverance and frustration with limitation were also evident. a rational desire to avoid pain exacerbation and medical intervention motivated restrictions to activity. However, deliberative limitation of activity has the potential to compromise autonomy by increasing social isolation and de-conditioning. Supporting older people with pain to be active requires sensitivity to the function of activity restriction, especially as a means of preventing deterioration.

What are the Effects of Protest Fear?

DTIC Science & Technology

2014-06-17

Acquisition Professional Development Program AT&L Acquisition, Technology, and Logistics BPA blanket purchase agreement CONUS continental United States...Blanket Purchase Agreement [ BPA ]) in order to avoid a bid protest. The data shows that 88 respondents had done so throughout their career with 4,139

The influence of animal fear on attentional capture by fear-relevant animal stimuli in children.

PubMed

Waters, Allison M; Lipp, Ottmar V

2008-01-01

The present study demonstrated that pictures of fear-relevant animals, snakes and spiders, presented among backgrounds of other animal stimuli captured attention and interfered in the detection of a neutral target to the same extent in a large sample of unselected children (N=81). Moreover, detection of a neutral target animal was slowed more in the presence of a feared fear-relevant distracter, e.g., a snake for snake fearful children, than in the presence of a not feared fear-relevant distracter, e.g., a spider for snake fearful children. These results indicate attentional capture by phylogenetically fear-relevant animal stimuli in children and the selective enhancement of this effect by fear of these animals. These findings are consistent with current models of preferential processing of phylogenetically prepared threat stimuli and with cognitive models of anxiety that propose an enhancing effect of fear in the processing of fear-related stimuli.

Extensibility of the hamstrings is best explained by mechanical components of muscle contraction, not behavioral measures in individuals with chronic low back pain.

PubMed

Marshall, Paul W M; Mannion, Jamie; Murphy, Bernadette A

2009-08-01

To examine the relationship between hamstring extensibility by use of the instrumented straight leg raise; mechanical components of muscle contraction, including muscle recruitment, passive torque measures of tissue stiffness, and eccentric strength; and self-reported measures of pain and disability. Cross-sectional study. University laboratory. Twenty-one individuals with chronic nonspecific axial lower back pain and 15 healthy control subjects. Instrumented straight leg raise, concentric and eccentric hamstring strength, self-reported measures of pain, disability, fear avoidance, general health and well-being Objective measures included hamstring extensibility, hamstring muscle stiffness, absolute and relative concentric/eccentric strength, concentric/eccentric strength ratios. Self-reported measures included Oswestry disability index, visual analog pain scale, fear avoidance beliefs, and general health and well being. Patients with lower back pain had lower range of motion, greater changes in muscle stiffness, and impaired concentric-to-eccentric strength levels. Stepwise regression identified measures of stiffness as significantly predicting hamstring extensibility (adjusted r(2) = 0.58, F = 23.76, P < .001). Self-reported measures were not associated with extensibility. Gender differences were noted for passive stiffness and absolute strength. For women, later onset of the medial hamstrings also was associated with greater hamstring extensibility. Decreased extensibility of the hamstrings was associated with increased passive stiffness during the common range of motion (20 to 50 degrees ). Impaired stretch tolerance is associated with actual mechanical restriction, not behavioral measures indicating increased pain or fear-avoidant behavior. With no relationship to actual disability and contradictory findings in the literature for the relationship of the hamstrings to the mechanics of the low back, it is unclear whether decreased hamstring extensibility should be targeted in rehabilitation programs for axial lower back pain.

Evaluation of the benefits of low back pain patients' education workshops during spa therapy.

PubMed

Gremeaux, Vincent; Benaïm, Charles; Poiraudeau, Serge; Hérisson, Christian; Dupeyron, Arnaud; Coudeyre, Emmanuel

2013-01-01

To evaluate the medium-term impact of education workshops on low back pain (LBP) in the setting of a thermal spa on: fear-avoidance beliefs, disability, pain, and satisfaction. Randomized prospective alternate-month design-type study including 360 individuals having thermal spa therapy for LBP: 188 in the intervention group (three standardized education workshops lasting 1 h 30 each and usual thermal therapy for 3 weeks), 172 in the control group (usual thermal therapy and non-standardized verbal information). The principal analysis criterion was the difference in the fear-avoidance beliefs (physical FABQ) score between baseline and 6 months after the therapy; secondary criteria were: evolution of disability (Quebec Scale) and pain intensity (Visual Analogue Scale), and satisfaction with the information received. There was a significant reduction in the physical FABQ score at 6 months (P<0.05), and this reduction was more marked in the intervention group (-5.8±0.7 vs. -2±0.72 points out of 24; P<0.0001). Disability and pain significantly decreased in both groups (P<0.05), with no difference between groups. These workshops also had a significant effect on satisfaction with the information received. Standardized education workshops have a beneficial impact on LBP and contribute to an improvement in the medical services provided during spa therapy by reducing the effect of fear-avoidance beliefs as well as relieving pain. Extending the use of such workshops could contribute to enhance the positive impact of spa therapy in the management of chronic disabling diseases. Copyright © 2012 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Slope climbing challenges, fear of heights, anxiety and time of the day.

PubMed

Ennaceur, A; Hussain, M D; Abuhamdah, R M; Mostafa, R M; Chazot, P L

2017-01-01

When exposed to an unfamiliar open space, animals experience fear and attempt to find an escape route. Anxiety emerges when animals are confronted with a challenging obstacle to this fear motivated escape. High anxiety animals do not take risks; they avoid the challenge. The present experiments investigated this risk avoidant behavior in mice. In experiment 1, BALB/c, C57BL/6J and CD-1 mice were exposed to a large platform with downward inclined steep slopes attached on two opposite sides. The platform was elevated 75 and 100cm from the ground, in a standard (SPDS) and in a raised (RPDS) configuration, respectively. In experiment 2, the platform was elevated 75cm from the ground. Mice had to climb onto a stand at the top of upward inclined slopes (SPUS). In experiment 3, BALB/c mice were exposed to SPDS with steep or shallow slopes either in early morning or in late afternoon. In all 3 test configurations, mice spent more time in the areas adjacent to the slopes than in the areas adjacent to void, however only C57BL/6J and CD-1 crossed onto the slopes in SPDS, and crossed onto the stands in SPUS whereas BALB/c remained on the platform in SPDS and explored the slopes in SPUS. Elevation of the platform from the ground reduced the crossings onto the slopes in C57BL/6J and CD-1, and no differences were observed between BALB/c and C57BL/6J. BALB/c mice demonstrated no difference in anxiety when tested early morning or late afternoon; they crossed onto shallow slopes and avoided the steep one. Copyright © 2016 Elsevier B.V. All rights reserved.

Biopsychosocial factors associated with chronic low back pain disability in rural Nigeria: a population-based cross-sectional study

PubMed Central

Coker, Bolaji; Onwasigwe, Chika N; Sorinola, Isaac O; Godfrey, Emma L

2017-01-01

Introduction Many people in Nigeria are living with disability due to chronic low back pain (CLBP), with the greatest burden accounted for by people living in rural Nigeria. However, factors associated with disability in rural Nigeria have not yet been established. We investigated the biomechanical and psychosocial predictors of CLBP disability in a rural Nigerian population. Methods A cross-sectional study of adults with non-specific CLBP recruited from rural communities in Enugu State, South-eastern Nigeria. Measures of self-reported and performance-based disability, pain intensity, anxiety and depression, coping strategies, social support, occupational biomechanical factors, illness perceptions and fear avoidance beliefs were collected by trained community health workers. We used univariate and multivariate analyses. Results 200 individuals were recruited. Psychosocial factors were the most important factors associated with CLBP disability, and accounted for 62.5% and 49.1% of the variance in self-reported and performance-based disability, respectively. The significant predictors of self-reported disability were: illness perceptions (β=0.289; p<0.0005), pain intensity (β=0.230; p<0.0005), catastrophising (β=0.210; p=0.001), fear avoidance beliefs (β=0.198; p=0.001) and anxiety (β=0.154; p=0.023). The significant predictors of performance-based disability were: illness perceptions (β=0.366; p<0.0005), social support (β=0.290; p<0.0005), fear avoidance beliefs (β=0.189; p<0.01) and female gender (β=0.184; p<0.01). Illness concern was the most salient dimension of illness perceptions predicting self-reported and performance-based disability. Conclusions These results provide evidence which can be used to inform the development of interventions to reduce CLBP disability in rural Nigeria, and may have relevance in other rural African contexts. PMID:29225944

Determinants of “return to work in good health” among workers with back pain who consult in primary care settings: a 2-year prospective study

PubMed Central

Bourbonnais, Renée; Frémont, Pierre; Rossignol, Michel; Stock, Susan R.; Nouwen, Arie; Larocque, Isabelle; Demers, Eric

2006-01-01

Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of “return to work in good health” (RWGH—a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects (n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of “success” in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of “failure” in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success. PMID:16868783

Development of a laboratory model to assess fear and anxiety in cats.

PubMed

de Rivera, Christina; Ley, Jacqui; Milgram, Bill; Landsberg, Gary

2017-06-01

Objectives The objectives of this study were: (1) to develop a laboratory-based model to assess fear and anxiety in cats using the feline open-field test (OFT) and the feline human interaction test (HIT); and (2) to validate the model using diazepam, a known anxiolytic. Methods Laboratory-housed cats (n = 41) were first classified as fearful, mildly fearful or non-fearful by a technician familiar with the cats and also by veterinary behaviorists (GL, JL), by assessing the cats' behavior in their home rooms. In experiment 1, each cat's behavior was assessed in an OFT and an HIT. In experiment 2, after administration of the anxiolytic diazepam, a subset of the cats was re-tested. Results In experiment 1, the OFT revealed significant group effects on two measures: duration of inactivity, and vocalization. Fearful animals had significantly longer periods of inactivity than non-fearful animals. Non-fearful and mildly fearful cats vocalized more frequently than fearful cats. In the HIT, fearful cats travelled less than non-fearful and mildly fearful cats. Fearful and mildly fearful animals had significantly longer durations of inactivity, and non-fearful and mildly fearful cats had a significantly higher frequency of vocalization compared with fearful cats. In experiment 2, in the OFT, treatment with diazepam caused an increase in distance travelled, shorter durations of inactivity, and more frequent inactivity and vocalization. In the HIT, diazepam increased distance travelled and decreased duration of inactivity. Fearful cats spent significantly less time near the human compared with non-fearful cats, and this persisted under diazepam. Conclusions and relevance The feline OFT and feline HIT can be used jointly to assess the effects of medications or other therapies on fear and anxiety in the domestic cat.

Barriers to Social Participation among Lonely Older Adults: The Influence of Social Fears and Identity

PubMed Central

Goll, Johanna C.; Charlesworth, Georgina; Scior, Katrina; Stott, Joshua

2015-01-01

Introduction Loneliness among older adults is a major public health problem that may be associated with processes of social participation and identity. This study therefore sought to examine the relationship between social participation and identity in a sample of lonely older adults living independently in London, England. Method An inductive qualitative approach, based on semi-structured interviews and thematic analysis, was employed. Results Participants commonly spoke of barriers to social participation that have been reported elsewhere, including illness/disability, loss of contact with friends/relatives, lack of a supportive community, and lack of acceptable social opportunities. However, novel findings were also derived. In particular, participants commonly minimised the difficulties they faced alone, and described attempts to avoid social opportunities. These behaviours were linked to fears about engaging in social participation opportunities, including fears of social rejection and/or exploitation, and fears of losing valued aspects of identity. Discussion It is concluded that social participation amongst lonely older people will not improve through the removal of previously reported barriers alone; instead, older peoples’ beliefs, fears and identities must be addressed. Suggestions for implementing these findings within community organisations are provided. PMID:25706933

The key role of extinction learning in anxiety disorders: behavioral strategies to enhance exposure-based treatments.

PubMed

Pittig, Andre; van den Berg, Linda; Vervliet, Bram

2016-01-01

Extinction learning is a major mechanism for fear reduction by means of exposure. Current research targets innovative strategies to enhance fear extinction and thereby optimize exposure-based treatments for anxiety disorders. This selective review updates novel behavioral strategies that may provide cutting-edge clinical implications. Recent studies provide further support for two types of enhancement strategies. Procedural enhancement strategies implemented during extinction training translate to how exposure exercises may be conducted to optimize fear extinction. These strategies mostly focus on a maximized violation of dysfunctional threat expectancies and on reducing context and stimulus specificity of extinction learning. Flanking enhancement strategies target periods before and after extinction training and inform optimal preparation and post-processing of exposure exercises. These flanking strategies focus on the enhancement of learning in general, memory (re-)consolidation, and memory retrieval. Behavioral strategies to enhance fear extinction may provide powerful clinical applications to further maximize the efficacy of exposure-based interventions. However, future replications, mechanistic examinations, and translational studies are warranted to verify long-term effects and naturalistic utility. Future directions also comprise the interplay of optimized fear extinction with (avoidance) behavior and motivational antecedents of exposure.

Death Attitudes and Changes in Existential Outlook in Parents of Vulnerable Newborns.

PubMed

Barr, Peter

2015-01-01

This study is an Actor-Partner Interdependence Model analysis of the relation of death attitudes with changes in outlook in 59 parent couples of neonatal intensive care newborns. Death attitudes effects with changes in outlook were mostly intrapersonal and they mainly occurred in fathers, though between gender differences were not usually significant. Death avoidance and neutral death acquiescence were positive predictors of positive changes in outlook, and fear of death and neutral death acquiescence were respective positive and inverse predictors of negative changes. Multidimensional measures of death attitudes and personal change should be used when studying these domains of psychological functioning.

Reduction of pain-related fear and increased function and participation in work-related upper extremity pain (WRUEP): effects of exposure in vivo.

PubMed

de Jong, Jeroen R; Vlaeyen, Johan W S; van Eijsden, Marjon; Loo, Christoph; Onghena, Patrick

2012-10-01

There is increasing evidence that pain-related fear influences the development and maintenance of pain disability, presumably mediated through the fear-related avoidance of valued activities. Individually tailored graded exposure in vivo (GEXP) has been demonstrated to reduce pain-related fear and increase functional abilities in patients with chronic low back pain, neck pain, and complex regional pain syndrome. The current study aimed to test whether these effects generalize towards patients with work-related upper extremity pain. A sequential replicated and randomized single-case experimental phase design with multiple measurements was used. Within each participant, GEXP was compared to a no-treatment baseline period and a no-treatment 6-month follow-up period. Eight patients who reported a high level of pain-related fear were included in the study. Daily changes in pain catastrophizing, pain-related fear, and pain intensity were assessed using a diary, and subjected to randomization tests. Before the start of the baseline period, just after GEXP, and at 6-month follow-up, clinically relevant changes of pain catastrophizing, pain-related fear, perceived harmfulness of physical activity, pain disability, and participation/autonomy were verified. When GEXP was introduced, levels of pain catastrophizing and pain-related fear decreased significantly. Clinically relevant improvements were observed for pain disability, perceived participation, and autonomy. These favourable changes were maintained until 6-month follow-up. The findings of the current study underscore the external validity of a cognitive-behavioural GEXP treatment for patients with chronic pain reporting increased pain-related fear. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Transitioning to a narrow path: the impact of fear of falling in older adults.

PubMed

Dunlap, Pamela; Perera, Subashan; VanSwearingen, Jessie M; Wert, David; Brach, Jennifer S

2012-01-01

Everyday ambulation requires navigation of variable terrain, transitions from wide to narrow pathways, and avoiding obstacles. While the effect of age on the transition to a narrow path has been examined briefly, little is known about the impact of fear of falling on gait during the transition to a narrow path. The purpose was to examine the effect of age and fear of falling on gait during transition to a narrow path. In 31 young, mean age=25.3 years, and 30 older adults, mean age=79.6 years, step length, step time, step width and gait speed were examined during usual and transition to narrow pathway using an instrumented walkway. During the transition to narrow walk condition, fearful older adults compared to young had a wider step width (0.06 m vs 0.04 m) prior to the narrow path and took shorter steps (0.53 m vs 0.72 m; p<0.001). Compared to non-fearful older adults, fearful older adults walked slower and took shorter steps during narrow path walking (gait speed: 1.1m/s vs 0.82 m/s; p=0.01; step length: 0.60 m vs 0.47 m; p=0.03). In young and non-fearful older adults narrow path gait was similar to usual gait. Whereas older adults who were fearful, walked slower (0.82 m/s vs 0.91 m/s; p=0.001) and took shorter steps (0.44 m vs 0.53 m; p=0.004) during narrow path walking compared to usual walking. Changes in gait characteristics with transitioning to a narrow pathway were greater for fear of falling than for age. Copyright © 2011 Elsevier B.V. All rights reserved.

The Genetic Covariation between Fear Conditioning and Self-Report Fears

PubMed Central

Hettema, John M.; Annas, Peter; Neale, Michael C.; Fredrikson, Mats; Sci, Dr Med; Kendler, Kenneth S.

2008-01-01

Background Fear conditioning is a traditional model for the acquisition of phobias, while behavioral therapies utilize processes underlying extinction to treat phobic and other anxiety disorders. Furthermore, fear conditioning has been proposed as an endophenotype for genetic studies of anxiety disorders. While prior studies have demonstrated that fear conditioning and self-report fears are heritable, no studies have determined whether they share a common genetic basis. Methods We obtained fear conditioning data from 173 twin pairs from the Swedish Twin Registry who also provided self-report ratings of 16 common fears. Using multivariate structural equation modeling, we analyzed factor-derived scores for the subjective fear ratings together with the electrophysiologic skin conductance responses during habituation, acquisition, and extinction to determine the extent of their genetic covariation. Results Phenotypic correlations between experimental and self-report fear measures were modest and, and counter-intuitively, negative; that is, subjects who reported themselves as more fearful had smaller electrophysiologic responses. Best-fit models estimated a significant (negative) genetic correlation between them, although genetic factors underlying fear conditioning accounted for only 9% of individual differences in self-report fears. Conclusions Experimentally-derived fear conditioning measures share only a small portion of the genetic factors underlying individual differences in subjective fears, cautioning against relying too heavily on the former as an endophenotype for genetic studies of phobic disorders. PMID:17698042

Early ERP Modulation for Task-Irrelevant Subliminal Faces

PubMed Central

Pegna, Alan J.; Darque, Alexandra; Berrut, Claire; Khateb, Asaid

2011-01-01

A number of investigations have reported that emotional faces can be processed subliminally, and that they give rise to specific patterns of brain activation in the absence of awareness. Recent event-related potential (ERP) studies have suggested that electrophysiological differences occur early in time (<200 ms) in response to backward-masked emotional faces. These findings have been taken as evidence of a rapid non-conscious pathway, which would allow threatening stimuli to be processed rapidly and subsequently allow appropriate avoidance action to be taken. However, for this to be the case, subliminal processing should arise even if the threatening stimulus is not attended. This point has in fact not yet been clearly established. In this ERP study, we investigated whether subliminal processing of fearful faces occurs outside the focus of attention. Fourteen healthy participants performed a line judgment task while fearful and non-fearful (happy or neutral) faces were presented both subliminally and supraliminally. ERPs were compared across the four experimental conditions (i.e., subliminal and supraliminal; fearful and non-fearful). The earliest differences between fearful and non-fearful faces appeared as an enhanced posterior negativity for the former at 170 ms (the N170 component) over right temporo-occipital electrodes. This difference was observed for both subliminal (p < 0.05) and supraliminal presentations (p < 0.01). Our results confirm that subliminal processing of fearful faces occurs early in the course of visual processing, and more importantly, that this arises even when the subject's attention is engaged in an incidental task. PMID:21687457

Gender Difference of Unconscious Attentional Bias in High Trait Anxiety Individuals

PubMed Central

Tan, Jieqing; Ma, Zheng; Gao, Xiaochao; Wu, Yanhong; Fang, Fang

2011-01-01

By combining binocular suppression technique and a probe detection paradigm, we investigated attentional bias to invisible stimuli and its gender difference in both high trait anxiety (HTA) and low trait anxiety (LTA) individuals. As an attentional cue, happy or fearful face pictures were presented to HTAs and LTAs for 800 ms either consciously or unconsciously (through binocular suppression). Participants were asked to judge the orientation of a gabor patch following the face pictures. Their performance was used to measure attentional effect induced by the cue. We found gender differences of attentional effect only in the unconscious condition with HTAs. Female HTAs exhibited difficulty in disengaging attention from the location where fearful faces were presented, while male HTAs showed attentional avoidance of it. Our results suggested that the failure to find attentional avoidance of threatening stimuli in many previous studies might be attributed to consciously presented stimuli and data analysis regardless of participants' gender. These findings also contributed to our understanding of gender difference in anxiety disorder. PMID:21647221

Gender difference of unconscious attentional bias in high trait anxiety individuals.

PubMed

Tan, Jieqing; Ma, Zheng; Gao, Xiaochao; Wu, Yanhong; Fang, Fang

2011-01-01

By combining binocular suppression technique and a probe detection paradigm, we investigated attentional bias to invisible stimuli and its gender difference in both high trait anxiety (HTA) and low trait anxiety (LTA) individuals. As an attentional cue, happy or fearful face pictures were presented to HTAs and LTAs for 800 ms either consciously or unconsciously (through binocular suppression). Participants were asked to judge the orientation of a gabor patch following the face pictures. Their performance was used to measure attentional effect induced by the cue. We found gender differences of attentional effect only in the unconscious condition with HTAs. Female HTAs exhibited difficulty in disengaging attention from the location where fearful faces were presented, while male HTAs showed attentional avoidance of it. Our results suggested that the failure to find attentional avoidance of threatening stimuli in many previous studies might be attributed to consciously presented stimuli and data analysis regardless of participants' gender. These findings also contributed to our understanding of gender difference in anxiety disorder.

Cruel to Be Kind: Factors Underlying Altruistic Efforts to Worsen Another Person's Mood.

PubMed

López-Pérez, Belén; Howells, Laura; Gummerum, Michaela

2017-07-01

When aiming to improve another person's long-term well-being, people may choose to induce a negative emotion in that person in the short term. We labeled this form of agent-target interpersonal emotion regulation altruistic affect worsening and hypothesized that it may happen when three conditions are met: (a) The agent experiences empathic concern for the target of the affect-worsening process, (b) the negative emotion to be induced helps the target achieve a goal (e.g., anger for confrontation or fear for avoidance), and (c) there is no benefit for the agent. This hypothesis was tested by manipulating perspective-taking instructions and the goal to be achieved while participants ( N = 140) played a computer-based video game. Participants following other-oriented perspective-taking instructions, compared with those following objective perspective-taking instructions, decided to induce more anger in a supposed fellow participant who was working to achieve a confrontation goal and to induce more fear in a supposed fellow participant who was working to achieve an avoidance goal.

Knowledge and perceptions about back education among elementary school students, teachers, and parents in Belgium.

PubMed

Cardon, Greet; De Bourdeaudhuij, Ilse; De Clercq, Dirk

2002-03-01

A back education program for Belgian elementary school children was evaluated using self-reported questionnaires before intervention and at three follow-up points during one year. Most children found the program interesting, important, and amusing. Intervention children (n = 347) showed better back care knowledge than control children (n = 359), and knowledge gained was retained over a period of one year. Back education did not result in increased fear-avoidance beliefs about physical activity, and intervention children reported more checking of their book bag weight than controls at all test moments. Self-reported behavior in relation to posture-related and back care related self-efficacy were affected only minimally by the program, possibly due to poor self-judgment. Involvement, fear-avoidance beliefs, and back care knowledge of teachers and parents of the intervention children showed low correlation with the children's perceptions and knowledge. Sufficient promise exists to justify further development and evaluation of early back education.

Rapid temporal accumulation in spider fear: Evidence from hierarchical drift diffusion modelling.

PubMed

Tipples, Jason

2015-12-01

Fear can distort sense of time--making time seem slow or even stand still. Here, I used hierarchical drift diffusion modeling (HDDM; Vandekerckhove, Tuerlinckx, & Lee, 2008, 2011; Wiecki, Sofer, & Frank, 2013) to test the idea that temporal accumulation speeds up during fear. Eighteen high fearful and 23 low fearful participants judged the duration of both feared stimuli (spiders) and nonfeared stimuli (birds) in a temporal bisection task. The drift diffusion modeling results support the main hypothesis. In high but not low fearful individuals, evidence accumulated more rapidly toward a long duration decision-drift rates were higher-for spiders compared with birds. This result and further insights into how fear affects time perception would not have been possible on the basis of analyses of choice proportion data alone. Further results were interpreted in the context of a recent 2-stage model of time perception (Balcı & Simen, 2014). The results highlight the usefulness of diffusion modeling to test process-based explanations of disordered cognition in emotional disorders. (c) 2015 APA, all rights reserved).

Inhibiting corticosterone synthesis during fear memory formation exacerbates cued fear extinction memory deficits within the single prolonged stress model.

PubMed

Keller, Samantha M; Schreiber, William B; Stanfield, Briana R; Knox, Dayan

2015-01-01

Using the single prolonged stress (SPS) animal model of post-traumatic stress disorder (PTSD), previous studies suggest that enhanced glucocorticoid receptor (GR) expression leads to cued fear extinction retention deficits. However, it is unknown how the endogenous ligand of GRs, corticosterone (CORT), may contribute to extinction retention deficits in the SPS model. Given that CORT synthesis during fear learning is critical for fear memory consolidation and SPS enhances GR expression, CORT synthesis during fear memory formation could strengthen fear memory in SPS rats by enhancing GR activation during fear learning. In turn, this could lead to cued fear extinction retention deficits. We tested the hypothesis that CORT synthesis during fear learning leads to cued fear extinction retention deficits in SPS rats by administering the CORT synthesis inhibitor metyrapone to SPS and control rats prior to fear conditioning, and observed the effect this had on extinction memory. Inhibiting CORT synthesis during fear memory formation in control rats tended to decrease cued freezing, though this effect never reached statistical significance. Contrary to our hypothesis, inhibiting CORT synthesis during fear memory formation disrupted extinction retention in SPS rats. This finding suggests that even though SPS exposure leads to cued fear extinction memory deficits, CORT synthesis during fear memory formation enhances extinction retention in SPS rats. This suggests that stress-induced CORT synthesis in previously stressed rats can be beneficial. Copyright © 2015 Elsevier B.V. All rights reserved.

Are Pain-Related Fears Mediators for Reducing Disability and Pain in Patients with Complex Regional Pain Syndrome Type 1? An Explorative Analysis on Pain Exposure Physical Therapy

PubMed Central

Barnhoorn, Karlijn J.; Staal, J. Bart; van Dongen, Robert T. M.; Frölke, Jan Paul M.; Klomp, Frank P.; van de Meent, Henk; Samwel, Han; Nijhuis-van der Sanden, Maria W. G.

2015-01-01

Objective To investigate whether pain-related fears are mediators for reducing disability and pain in patients with Complex Regional Pain Syndrome type 1 when treating with Pain Exposure Physical Therapy. Design An explorative secondary analysis of a randomised controlled trial. Participants Fifty-six patients with Complex Regional Pain Syndrome type 1. Interventions The experimental group received Pain Exposure Physical Therapy in a maximum of five treatment sessions; the control group received conventional treatment following the Dutch multidisciplinary guideline. Outcome measures Levels of disability, pain, and pain-related fears (fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were measured at baseline and after 3, 6, and 9 months follow-up. Results The experimental group had a significantly larger decrease in disability of 7.77 points (95% CI 1.09 to 14.45) and in pain of 1.83 points (95% CI 0.44 to 3.23) over nine months than the control group. The potential mediators pain-related fears decreased significantly in both groups, but there were no significant differences between groups, which indicated that there was no mediation. Conclusion The reduction of pain-related fears was comparable in both groups. We found no indication that pain-related fears mediate the larger reduction of disability and pain in patients with Complex Regional Pain Syndrome type 1 treated with Pain Exposure Physical Therapy compared to conventional treatment. Trial registration International Clinical Trials Registry NCT00817128 PMID:25919011

Toll-Like Receptor 4 Deficiency Causes Reduced Exploratory Behavior in Mice Under Approach-Avoidance Conflict.

PubMed

Li, Chunlu; Yan, Yixiu; Cheng, Jingjing; Xiao, Gang; Gu, Jueqing; Zhang, Luqi; Yuan, Siyu; Wang, Junlu; Shen, Yi; Zhou, Yu-Dong

2016-04-01

Abnormal approach-avoidance behavior has been linked to deficits in the mesolimbic dopamine (DA) system of the brain. Recently, increasing evidence has indicated that toll-like receptor 4 (TLR4), an important pattern-recognition receptor in the innate immune system, can be directly activated by substances of abuse, resulting in an increase of the extracellular DA level in the nucleus accumbens. We thus hypothesized that TLR4-dependent signaling might regulate approach-avoidance behavior. To test this hypothesis, we compared the novelty-seeking and social interaction behaviors of TLR4-deficient (TLR4(-/-)) and wild-type (WT) mice in an approach-avoidance conflict situation in which the positive motivation to explore a novel object or interact with an unfamiliar mouse was counteracted by the negative motivation to hide in exposed, large spaces. We found that TLR4(-/-) mice exhibited reduced novelty-seeking and social interaction in the large open spaces. In less stressful test apparatuses similar in size to the mouse cage, however, TLR4(-/-) mice performed normally in both novelty-seeking and social interaction tests. The reduced exploratory behaviors under approach-avoidance conflict were not due to a high anxiety level or an enhanced fear response in the TLR4(-/-) mice, as these mice showed normal anxiety and fear responses in the open field and passive avoidance tests, respectively. Importantly, the novelty-seeking behavior in the large open field induced a higher level of c-Fos activation in the nucleus accumbens shell (NAcSh) in TLR4(-/-) mice than in WT mice. Partially inactivating the NAcSh via infusion of GABA receptor agonists restored the novelty-seeking behavior of TLR4(-/-) mice. These data suggested that TLR4 is crucial for positive motivational behavior under approach-avoidance conflict. TLR4-dependent activation of neurons in the NAcSh may contribute to this phenomenon.

An empirical analysis of Moscovitch's reconceptualised model of social anxiety: How is it different from fear of negative evaluation?

PubMed

Kizilcik, Isilay N; Gregory, Bree; Baillie, Andrew J; Crome, Erica

2016-01-01

Cognitive-behavioural models propose that excessive fear of negative evaluation is central to social anxiety. Moscovitch (2009) instead proposes that perceived deficiencies in three self attributes: fears of showing signs of anxiety, deficits in physical appearance, or deficits in social competence are at the core of social anxiety. However, these attributes are likely to overlap with fear of negative evaluation. Responses to an online survey of 286 participants with a range of social anxiety severity were analysed using hierarchical multiple regression to identify the overall unique predictive value of Moscovitch's model. Altogether, Moscovitch's model provided improvements in the prediction of safety behaviours, types of fears and cognitions; however only the fear of showing anxiety subscale provided unique information. This research supports further investigations into the utility of this revised model, particularly related to utility of explicitly assessing and addressing fears of showing anxiety. Copyright © 2015 Elsevier Ltd. All rights reserved.

Physiotherapists' beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies.

PubMed

Gardner, Tania; Refshauge, Kathryn; Smith, Lorraine; McAuley, James; Hübscher, Markus; Goodall, Stephen

2017-07-01

What influence do physiotherapists' beliefs and attitudes about chronic low back pain have on their clinical management of people with chronic low back pain? Systematic review with data from quantitative and qualitative studies. Quantitative and qualitative studies were included if they investigated an association between physiotherapists' attitudes and beliefs about chronic low back pain and their clinical management of people with chronic low back pain. Five quantitative and five qualitative studies were included. Quantitative studies used measures of treatment orientation and fear avoidance to indicate physiotherapists' beliefs and attitudes about chronic low back pain. Quantitative studies showed that a higher biomedical orientation score (indicating a belief that pain and disability result from a specific structural impairment, and treatment is selected to address that impairment) was associated with: advice to delay return to work, advice to delay return to activity, and a belief that return to work or activity is a threat to the patient. Physiotherapists' fear avoidance scores were positively correlated with: increased certification of sick leave, advice to avoid return to work, and advice to avoid return to normal activity. Qualitative studies revealed two main themes attributed to beliefs and attitudes of physiotherapists who have a relationship to their management of chronic low back pain: treatment orientation and patient factors. Both quantitative and qualitative studies showed a relationship between treatment orientation and clinical practice. The inclusion of qualitative studies captured the influence of patient factors in clinical practice in chronic low back pain. There is a need to recognise that both beliefs and attitudes regarding treatment orientation of physiotherapists, and therapist-patient factors need to be considered when introducing new clinical practice models, so that the adoption of new clinical practice is maximised. [Gardner T, Refshauge K, Smith L, McAuley J, Hübscher M, Goodall S (2017) Physiotherapists' beliefs and attitudes influence clinical practice in chronic low back pain: a systematic review of quantitative and qualitative studies. Journal of Physiotherapy 63: 132-143]. Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Symbolic online exposure for spider fear: habituation of fear, disgust and physiological arousal and predictors of symptom improvement.

PubMed

Matthews, Allison; Naran, Nishma; Kirkby, Kenneth C

2015-06-01

This research compared the effects of real versus hyper-real images on anxiety, disgust, and physiological arousal during internet-delivered exposure in high spider-fearfuls. Hyper-real images were digitally altered to highlight fearful aspects. A further aim was to examine self-reported and behavioural therapeutic outcomes and exposure-related predictors of these outcomes. Twenty-eight females were randomised to real (n = 14) or hyper-real (n = 14) treatment groups and nine participants were subsequently allocated to a wait-list control group. Treatment groups viewed an 8-stage exposure hierarchy of real or hyper-real spider images. Subjective anxiety and disgust ratings were taken during each stage (0, 60, 120, 180 s) with heart rate and skin conductance recorded throughout. Anxiety, disgust and physiological arousal habituated within each exposure stage, with no differential effect of real compared to hyper-real images. Both treatment groups but not controls demonstrated significant reductions in behavioural avoidance and self-reported phobic symptoms from pre-treatment to post-treatment with large effect sizes noted. The change in within-stage habituation of anxiety, disgust and heart rate, between the first and last stage, predicted improvement in behavioural avoidance at post-treatment. This suggests that generalisation of habituation to multiple images is an important predictor of improvement. While findings in relation to therapeutic outcome should be considered preliminary, clear relationships were found between exposure-related variables and outcome among those who undertook treatment. Findings provide evidence in support of the efficacy of online image-based exposure and have implications for informing further research into the underlying mechanisms of image-based exposure treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

The opinion of Turkish cardiologists on current malpractice system and an alternative patient compensation system proposal: PCS study group.

PubMed

Olcay, Ayhan; Emren, Sadık Volkan; Babür Güler, Gamze; Güler, Ekrem; Ertunç, Vedat; Berilgen, Rida; Aslan, Abdullah; Şimşek, Ersin Çağrı; Gölcük, Şükriye Ebru; Yalın, Kıvanç

2017-10-01

Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists' diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system. The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message. A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients. The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice system.

Visual exploration during locomotion limited by fear of heights.

PubMed

Kugler, Günter; Huppert, Doreen; Eckl, Maria; Schneider, Erich; Brandt, Thomas

2014-01-01

Visual exploration of the surroundings during locomotion at heights has not yet been investigated in subjects suffering from fear of heights. Eye and head movements were recorded separately in 16 subjects susceptible to fear of heights and in 16 non-susceptible controls while walking on an emergency escape balcony 20 meters above ground level. Participants wore mobile infrared eye-tracking goggles with a head-fixed scene camera and integrated 6-degrees-of-freedom inertial sensors for recording head movements. Video recordings of the subjects were simultaneously made to correlate gaze and gait behavior. Susceptibles exhibited a limited visual exploration of the surroundings, particularly the depth. Head movements were significantly reduced in all three planes (yaw, pitch, and roll) with less vertical head oscillations, whereas total eye movements (saccade amplitudes, frequencies, fixation durations) did not differ from those of controls. However, there was an anisotropy, with a preference for the vertical as opposed to the horizontal direction of saccades. Comparison of eye and head movement histograms and the resulting gaze-in-space revealed a smaller total area of visual exploration, which was mainly directed straight ahead and covered vertically an area from the horizon to the ground in front of the feet. This gaze behavior was associated with a slow, cautious gait. The visual exploration of the surroundings by susceptibles to fear of heights differs during locomotion at heights from the earlier investigated behavior of standing still and looking from a balcony. During locomotion, anisotropy of gaze-in-space shows a preference for the vertical as opposed to the horizontal direction during stance. Avoiding looking into the abyss may reduce anxiety in both conditions; exploration of the "vertical strip" in the heading direction is beneficial for visual control of balance and avoidance of obstacles during locomotion.

The Relationship of Self-Disclosure to Personality, Adjustment and Self-Actualization

ERIC Educational Resources Information Center

Lombardo, John P.; Fantasia, Saverio C.

1976-01-01

Tested the hypothesis that a high level of self-disclosure is indicative of psychological adjustment and self-actualization. The self-disclosure scale, Social Avoidance and Distress, Fear of Negative Evaluation, Alienation and Repression-Sensitization scales were administered to 60 introductory psychology students. (Editor/RK)

Order Up

ERIC Educational Resources Information Center

Gibeault, Michael

2005-01-01

Change orders. The words can turn the stomachs of administrators. Horror stories about change orders create fear and distrust among school officials, designers and builders. Can change orders be avoided? If car manufacturers can produce millions of intricately designed vehicles, why can't the same quality control be achieved on a construction…

Programming Proficiency in One Semester: Lessons Learned

ERIC Educational Resources Information Center

Colton, Don; Curtis, Aaron

2010-01-01

Programming is a fundamental skill for Information Systems and Information Technology students. It is also a subject that some students fear, avoid, fail, retake, and fail again. An effective, inexpensive, one-semester approach is presented. Early indications suggest dramatically improved student interest and performance compared to our previous…

The Longitudinal Impact of Parent Distress and Behavior on Functional Outcomes Among Youth With Chronic Pain.

PubMed

Chow, Erika T; Otis, John D; Simons, Laura E

2016-06-01

Accumulating evidence supports the concurrent association between parent distress and behavior and child functioning in the context of chronic pain, with existing longitudinal studies limited to a pediatric surgical context that identify parent catastrophizing as influential. In this study, we examined how parent factors assessed at a multidisciplinary pediatric pain clinic evaluation affect child psychological and functional outcomes over time. A cohort of 195 patients with chronic pain (ages 8-17 years) and their parents who presented for a multidisciplinary evaluation completed measures at baseline and at 4-month follow-up. Patients completed measures of pain catastrophizing, pain-related fear and avoidance, generalized anxiety, depressive symptoms, and functional disability. Parents completed measures of pain catastrophizing, pain-related fear and avoidance, and protective responses to child pain. Parent-reported child school functioning was also collected. Parent distress and behavior was concurrently associated with child distress and functioning at evaluation. After controlling for baseline child functioning, baseline parent avoidance and protective behavior emerged as significant predictors of child functioning at 4-month follow-up. Parent distress and behavior influence child distress and functioning over time and these findings identify key parent domains to target in the context of a child's pain treatment. Parent behavior, specifically avoidance and protective responses, influence child distress and functioning over time. Child pain treatment interventions should include influential parent factors to ensure successful outcomes. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Fear of Crime in the Sanctuary: Comparing American and Ghanaian University Students' Fearfulness.

PubMed

Boateng, Francis D

2018-02-01

While much is known about fear of crime in the West, little is known about how fearfulness of crime develops in non-Western societies, especially among university students. Representing the first attempt to empirically compare levels of fear of crime between Ghanaian and U.S. college students, this article examined students' levels of fear of crime on campus, and tested the applicability of two evolving models of fear of crime-the vulnerability and reassurance models-using comparative data. The general finding is that Ghanaian and U.S. college students differ in terms of their rates of fearfulness on campus. This significant difference adds to the already existing differences between the two countries.

Pain in context: Cues predicting a reward decrease fear of movement related pain and avoidance behavior.

PubMed

Claes, Nathalie; Vlaeyen, Johan W S; Crombez, Geert

2016-09-01

Previous research shows that goal-directed behavior might be modulated by cues that predict (dis)similar outcomes. However, the literature investigating this modulation with pain outcomes is scarce. Therefore, this experiment investigated whether environmental cues predicting pain or reward modulate defensive pain responding. Forty-eight healthy participants completed a joystick movement task with two different movement orientations. Performing one movement was associated with a painful stimulus, whereas performance of another movement was associated with reward, i.e. lottery tickets. In a subsequent task, participants learned to associate three different cues withpain, reward, or neither of the two. Next, these cues were integrated in the movement task. This study demonstrates that in general, aversive cues enhance and appetitive cues reduce pain-related fear. Furthermore, we found that incongruence between the outcomes predicted by the movement and the cue results in more oscillatory behavior, i.e., participants were more willing to perform a painful movement when a cue predicting reward was simultaneously presented, and vice versa. Similarly, when given a choice, participants preferred to perform the reward movement, unless there was an incongruence between the outcomes predicted by the movements and cues. Taken together, these results provide experimental evidence that environmental cues are capable of modulating pain-related fear and avoidance behavior. Copyright © 2016 Elsevier Ltd. All rights reserved.

Attention bias modification in specific fears: Spiders versus snakes.

PubMed

Luo, Xijia; Ikani, Nessa; Barth, Anja; Rengers, Lea; Becker, Eni; Rinck, Mike

2015-12-01

Attention Bias Modification (ABM) is used to manipulate attention biases in anxiety disorders. It has been successful in reducing attention biases and anxious symptoms in social anxiety and generalized anxiety, but not yet in specific fears and phobias. We designed a new version of the dot-probe training task, aiming to train fearful participants' attention away from or towards pictures of threatening stimuli. Moreover, we studied whether the training also affected participants' avoidance behavior and their physical arousal upon being confronted with a real threat object. In Experiment 1, students with fear of spiders were trained. We found that the attention manipulation was successful, but the training failed to affect behavior or arousal. In Experiment 2, the same procedure was used on snake-fearful students. Again, attention was trained in the expected directions. Moreover, participants whose attention had been trained away from snakes showed lower physiological arousal upon being confronted with a real snake. The study involved healthy students with normal distribution of the fear of spider/snake. Future research with clinical sample could help with determining the generalizability of the current findings. The effect of ABM on specific phobia is still in question. The finding in the present study suggested the possibility to alter attentional bias with a dot-probe task with general positive stimuli and this training could even affect the behavior while encountering a real threat. Copyright © 2015 Elsevier Ltd. All rights reserved.

Disgust: the disease-avoidance emotion and its dysfunctions

PubMed Central

Davey, Graham C. L.

2011-01-01

This review analyses the accumulating evidence from psychological, psychophysiological, neurobiological and cognitive studies suggesting that the disease-avoidance emotion of disgust is a predominant emotion experienced in a number of psychopathologies. Current evidence suggests that disgust is significantly related to small animal phobias (particularly spider phobia), blood–injection–injury phobia and obsessive–compulsive disorder contamination fears, and these are all disorders that have primary disgust elicitors as a significant component of their psychopathology. Disgust propensity and sensitivity are also significantly associated with measures of a number of other psychopathologies, including eating disorders, sexual dysfunctions, hypochondriasis, height phobia, claustrophobia, separation anxiety, agoraphobia and symptoms of schizophrenia—even though many of these psychopathologies do not share the disease-avoidance functionality that characterizes disgust. There is accumulating evidence that disgust does represent an important vulnerability factor for many of these psychopathologies, but when disgust-relevant psychopathologies do meet the criteria required for clinical diagnosis, they are characterized by significant levels of both disgust and fear/anxiety. Finally, it has been argued that disgust may also facilitate anxiety and distress across a broad range of psychopathologies through its involvement in more complex human emotions such as shame and guilt, and through its effect as a negative affect emotion generating threat-interpretation biases. PMID:22042921

Bilateral Alternating Auditory Stimulations Facilitate Fear Extinction and Retrieval.

PubMed

Boukezzi, Sarah; Silva, Catarina; Nazarian, Bruno; Rousseau, Pierre-François; Guedj, Eric; Valenzuela-Moguillansky, Camila; Khalfa, Stéphanie

2017-01-01

Disruption of fear conditioning, its extinction and its retrieval are at the core of posttraumatic stress disorder (PTSD). Such deficits, especially fear extinction delay, disappear after alternating bilateral stimulations (BLS) during eye movement desensitization and reprocessing (EMDR) therapy. An animal model of fear recovery, based on auditory cued fear conditioning and extinction learning, recently showed that BLS facilitate fear extinction and fear extinction retrieval. Our goal was to determine if these previous results found in animals can be reproduced in humans. Twenty-two healthy participants took part in a classical fear conditioning, extinction, and extinction recall paradigm. Behavioral responses (fear expectations) as well as psychophysiological measures (skin conductance responses, SCRs) were recorded. The results showed a significant fear expectation decrease during fear extinction with BLS. Additionally, SCR for fear extinction retrieval were significantly lower with BLS. Our results demonstrate the importance of BLS to reduce negative emotions, and provide a successful model to further explore the neural mechanisms underlying the sole BLS effect in the EMDR.

Bilateral Alternating Auditory Stimulations Facilitate Fear Extinction and Retrieval

PubMed Central

Boukezzi, Sarah; Silva, Catarina; Nazarian, Bruno; Rousseau, Pierre-François; Guedj, Eric; Valenzuela-Moguillansky, Camila; Khalfa, Stéphanie

2017-01-01

Disruption of fear conditioning, its extinction and its retrieval are at the core of posttraumatic stress disorder (PTSD). Such deficits, especially fear extinction delay, disappear after alternating bilateral stimulations (BLS) during eye movement desensitization and reprocessing (EMDR) therapy. An animal model of fear recovery, based on auditory cued fear conditioning and extinction learning, recently showed that BLS facilitate fear extinction and fear extinction retrieval. Our goal was to determine if these previous results found in animals can be reproduced in humans. Twenty-two healthy participants took part in a classical fear conditioning, extinction, and extinction recall paradigm. Behavioral responses (fear expectations) as well as psychophysiological measures (skin conductance responses, SCRs) were recorded. The results showed a significant fear expectation decrease during fear extinction with BLS. Additionally, SCR for fear extinction retrieval were significantly lower with BLS. Our results demonstrate the importance of BLS to reduce negative emotions, and provide a successful model to further explore the neural mechanisms underlying the sole BLS effect in the EMDR. PMID:28659851

A cross species study of heterogeneity in fear extinction learning in relation to FKBP5 variation and expression: Implications for the acute treatment of posttraumatic stress disorder.

PubMed

Galatzer-Levy, Isaac R; Andero, Raül; Sawamura, Takehito; Jovanovic, Tanja; Papini, Santiago; Ressler, Kerry J; Norrholm, Seth Davin

2017-04-01

Deficits in fear extinction learning are hypothesized to underlie the development of posttraumatic stress disorder (PTSD). Such deficits may, in part, be due to genetic and epigenetic variation in the stress related gene FKBP5. Conversely, altering FKBP5 epigenetic responses during memory consolidation may rescue extinction deficits making it a target for acute intervention to prevent the development of PTSD. Study 1 (Humans) examines if FKBP5 single nucleotide polymorphisms (SNPs) and PTSD symptom domains (re-experiencing, avoidance/numbing, hyperarousal) are associated with abnormal fear extinction phenotypes identified using latent growth mixture modeling (LGMM). Study 2 (Mice) tests if increasing doses of dexamethasone administered prior to extinction alters Fkbp5 mRNA production in the amygdala after extinction and recall and prevents the development of abnormal extinction phenotypes. In humans, abnormal extinction was associated with the TT homozygous genotype of FKBP5 SNPs RS9470080 and RS1360780, and hyperarousal symptoms. In mice, dexamethasone 300 μg/kg was associated with increased amygdala Fkbp5 mRNA following extinction and robust extinction learning while lower doses were not associated with amygdala Fkbp5 mRNA or differences in extinction learning. Further, mice that extinguished on dexamethasone 300 μg/kg maintained low levels of freezing behavior during recall training while mRNA levels were no longer elevated. Together, findings indicate that FKBP5 confers risk for fear extinction deficits. However, this risk may be ameliorated by increasing fkbp5 mRNA expression in the amygdala during memory consolidation making this mechanism a plausible point of acute intervention to prevent the development of PTSD. Copyright © 2016 Elsevier Ltd. All rights reserved.

Looking beyond fear: the extinction of other emotions implicated in anxiety disorders.

PubMed

Mason, Elizabeth C; Richardson, Rick

2010-01-01

Previous research examining anxiety has traditionally focused on models of fear. More recently, attention has been directed to the role of disgust as an important emotion in the context of certain anxiety disorders. Further, it has been suggested that disgust, a form of evaluative responding, may be resistant to extinction and may contribute to relapse. However, previous work on this has largely relied on self-report ratings. In the current experiment, using a disgust conditioning and extinction procedure, disgust reactions were indeed shown to be resistant to extinction, as indexed by both self-report and an objective behavioral measure (visual avoidance). Furthermore, our research shows that individuals with greater levels of disgust sensitivity exhibit heightened resistance to extinction. In addition, expectancy of the disgusting US during extinction was dissociated from measures of disgust responding. Given that the treatment of choice for anxiety disorders (exposure therapy) is based on models of extinction, this research suggests that current treatments for anxiety disorders may not be adequately targeting disgust reactions, a crucial maintaining factor in certain anxiety disorders. As such, this inattention to disgust reactions may reduce the effectiveness of treatment in the short-term or may leave the patient vulnerable to relapse in the long-term.

Exacerbations of COPD: quantifying the patient's perspective using discrete choice modelling.

PubMed

Haughney, J; Partridge, M R; Vogelmeier, C; Larsson, T; Kessler, R; Ståhl, E; Brice, R; Löfdahl, C-G

2005-10-01

Patient-centred care is the current vogue in chronic obstructive pulmonary disease (COPD), but it is only recently that robust techniques have become available to determine patients' values and preferences. In this international cross-sectional study, patients' concerns and expectations regarding COPD exacerbations were explored using discrete choice modelling. A fractional factorial design was used to develop scenarios comprising a combination of levels for nine different attributes. In face-to-face interviews, patients were presented with paired scenarios and asked to choose the least preferable. Multinomial logit (with hierarchical Bayes) methods were used to estimate utilities. A total of 125 patients (82 males; mean age 66 yrs; 4.6 mean exacerbations.yr-1) were recruited. The attributes of exacerbations considered most important were impact on everyday life (20%), need for medical care (16%), number of future attacks (12%) and breathlessness (11%). The next most important attributes were speed of recovery, productive cough and social impact (all 9%), followed by sleep disturbance and impact on mood (both 7%). Importantly, analysis of utility shifts showed that patients most feared being hospitalised, housebound or bedridden. These issues were more important than symptom improvement. Strategies for the clinical management of chronic obstructive pulmonary disease should clearly address patients' concerns and focus on preventing and treating exacerbations to avoid these feared outcomes.

Fear Control an Danger Control: A Test of the Extended Parallel Process Model (EPPM).

ERIC Educational Resources Information Center

Witte, Kim

1994-01-01

Explores cognitive and emotional mechanisms underlying success and failure of fear appeals in context of AIDS prevention. Offers general support for Extended Parallel Process Model. Suggests that cognitions lead to fear appeal success (attitude, intention, or behavior changes) via danger control processes, whereas the emotion fear leads to fear…

Effective oral presentations: speaking before groups as part of your job.

PubMed

McConnell, Charles R

2009-01-01

Fear of public speaking is a widespread phenomenon that afflicts a large percentage of the population. Some working people will go to great lengths to avoid having to speak before a group; however, inability or unwillingness to speak in public can contribute to limiting an individual's promotional possibilities and thus capping a career at a level beneath the individual's technical abilities. This can be especially true in an arena such as health care in which oral communication in group settings figures so strongly in work relations. Yet anyone can overcome speaking fear through thorough preparation and practice. It is necessary to research one's topic thoroughly, outline the points the intended talk will cover, study the composition of one's audience, and plan on targeting some specific level of understanding and remaining ever conscious of the few areas in which problems can occur. With conscientious preparation and plenty of practice, anyone can learn to speak before any group of people, although it may mean facing one's fear head-on a number of times before gaining a level of confidence sufficient to control the fear of speaking.

Psychological Intrusion – An Overlooked Aspect of Dental Fear

PubMed Central

Chapman, Helen R.; Kirby-Turner, Nick

2018-01-01

Dental fear/anxiety is a widely recognised problem affecting a large proportion of the population. It can result in avoidance and/or difficulty accepting dental care. We believe that psychological intrusion may play a role in the aetiology and maintenance of dental fear for at least some individuals. In this narrative review we will take a developmental perspective in order to understand its impact across the lifespan. We will consider the nature of ‘self,’ parenting styles, the details of intrusive parenting or parental psychological control, and briefly touch upon child temperament and parental anxiety. Finally, we draw together the supporting (largely unrecognised) evidence available in the dental literature. We illustrate the paper with clinical examples and discuss possibly effective ways of addressing the problem. We conclude that psychological intrusion appears to play an important role in dental fear, for at least some individuals, and we call for detailed research into the extent and exact nature of the problem. A simple means of identifying individuals who are vulnerable to psychological intrusion would be useful for dentists. PMID:29719519

A twin study of the genetics of fear conditioning.

PubMed

Hettema, John M; Annas, Peter; Neale, Michael C; Kendler, Kenneth S; Fredrikson, Mats

2003-07-01

Fear conditioning is a traditional model for the acquisition of fears and phobias. Studies of the genetic architecture of fear conditioning may inform gene-finding strategies for anxiety disorders. The objective of this study was to determine the genetic and environmental sources of individual differences in fear conditioning by means of a twin sample. Classic fear conditioning data were experimentally obtained from 173 same-sex twin pairs (90 monozygotic and 83 dizygotic). Sequences of evolutionary fear-relevant (snakes and spiders) and fear-irrelevant (circles and triangles) pictorial stimuli served as conditioned stimuli paired with a mild electric shock serving as the unconditioned stimulus. The outcome measure was the electrodermal skin conductance response. We applied structural equation modeling methods to the 3 conditioning phases of habituation, acquisition, and extinction to determine the extent to which genetic and environmental factors underlie individual variation in associative and nonassociative learning. All components of the fear conditioning process in humans demonstrated moderate heritability, in the range of 35% to 45%. Best-fitting multivariate models suggest that 2 sets of genes may underlie the trait of fear conditioning: one that most strongly affects nonassociative processes of habituation that also is shared with acquisition and extinction, and a second that appears related to associative fear conditioning processes. In addition, these data provide tentative evidence of differences in heritability based on the fear relevance of the stimuli. Genes represent a significant source of individual variation in the habituation, acquisition, and extinction of fears, and genetic effects specific to fear conditioning are involved.

[How to properly use the fear in AIDS intervention-the history and further of fear appeal development].

PubMed

Zhang, Ke; Du, Xiufang; Tao, Xiaorun; Zhang, Yuanyuan; Kang, Dianmin

2015-08-01

The AIDS epidemic in men who have sex wlth men (MSM) in recent years showed a sharp upward trend, looking for behavioral intervention strategies should be imperative. Fear appeals by fear prompted intervention received intervention information, provide a new breakthrough to achieve better effect of propaganda and intervention. After over 70 years development, the Fear Appeal generated from the driver model that proposed the fear decided the effectiveness of behavior intervention, to the extended parallel process model theory which integrated protection motivation theory and parallel process theory, both of which believed the fear is just one of the estimators, suggested fear is the key factor. The fear appeal theory is turning to be even more comprehensive and accurate. As an important theoretical basement, the fear appeal is still developing, and need more work to make it perfection.

Experimental modification of interpretation bias about animal fear in young children: effects on cognition, avoidance behavior, anxiety vulnerability, and physiological responding.

PubMed

Lester, Kathryn J; Field, Andy P; Muris, Peter

2011-01-01

This study investigated the effects of experimentally modifying interpretation biases for children's cognitions, avoidance behavior, anxiety vulnerability, and physiological responding. Sixty-seven children (6-11 years) were randomly assigned to receive a positive or negative interpretation bias modification procedure to induce interpretation biases toward or away from threat about ambiguous situations involving Australian marsupials. Children rapidly learned to select outcomes of ambiguous situations, which were congruent with their assigned condition. Furthermore, following positive modification, children's threat biases about novel ambiguous situations significantly decreased, whereas threat biases significantly increased after negative modification. In response to a stress-evoking behavioral avoidance test, positive modification attenuated behavioral avoidance compared to negative modification. However, no significant effects of bias modification on anxiety vulnerability or physiological responses to this stress-evoking Behavioral Avoidance Task were observed.

The relationship between attachment orientations and the course of depression in coronary artery disease patients: A secondary analysis of the SPIRR-CAD trial.

PubMed

Söllner, Wolfgang; Müller, Markus M; Albus, Christian; Behnisch, Rüdiger; Beutel, Manfred E; de Zwaan, Martina; Fritzsche, Kurt; Habermeier, Anita; Hellmich, Martin; Jordan, Jochen; Jünger, Jana; Ladwig, Karl-Heinz; Michal, Matthias; Petrowski, Katja; Ronel, Joram; Stein, Barbara; Weber, Cora; Weber, Rainer; Herrmann-Lingen, Christoph

2018-05-01

The relationship between attachment orientations and the recovery from depressive symptoms in patients diagnosed with coronary artery disease (CAD) with and without a psychotherapeutic intervention was examined in this study. In a multicenter trial of 570 depressed CAD patients (SPIRR-CAD), assigned to usual care plus either a stepwise psychotherapy intervention or one information session, 522 patients provided attachment data at baseline. Attachment was measured with the Relationship Scales Questionnaire (RSQ), yielding four attachment orientations. The primary outcome was change in Hospital Anxiety and Depression Scale depression (HADS-D) scores from baseline to follow-up at 18 months. Secondary outcomes were HADS-D scores at 1, 6, 12, and 24 months. Independent of treatment assignment, attachment was related to change in depression at 18 months (p < 0.01) with secure attachment resulting in a significant reduction (-2.72, SE = 0.27) in depression compared to dismissive-avoidant (-1.51, SE = 0.35, p = 0.040) and fearful-avoidant (-0.65, SE = 0.61, p = 0.012) attachment. Patients with anxious-preoccupied attachment showed changes similar to secure attachment (-2.01, SE = 0.47). An explorative subgroup analysis across all assessment time points revealed patients with a dismissive-avoidant attachment benefitted from psychotherapy (average mean difference = 0.93, SE = 0.47, p = 0.048). Attachment played an important role for improvement in depressive symptoms. Only dismissive-avoidant patients seemed to benefit from the intervention. The lack of improvement in fearful-avoidant patients shows a need for specific interventions for this group. www.clinicaltrials.govNCT00705965; www.isrctn.com ISRCTN76240576. Copyright © 2018 Elsevier Inc. All rights reserved.

CHARACTER OF THE CHANGES IN FEAR MOTIVATED DECLARATIVE MEMORY IN THE HIGH IMMOBILIZATION "DEPRESSIVE" RATS.

PubMed

Nachkebia, N; Shavgulidze, M; Babilodze, M; Chkhartishvili, E; Rogava, N

2016-10-01

Present study investigated possible differences in the learning and memory of declarative memory task in rats selected according to the differences in immobilization response that is in high immobilization "depressive" and low immobilization "non-depressive" rats. Understanding the character of learning and memory disturbances in basal conditions of animal models of depression is still very topical for more intimate definition of the pathophysiology of major depressive disorder and appropriate searching the ways of its correction. Experiments were carried out on the adult white wild rats (with the weight 200-250 g, n=20). Selection of rats according to the level of immobilization was made by means of forced swim test. Learning and memory disturbances were studied using passive avoidance test that is fear motivated one trial declarative memory task. It was shown by us that 100% of low immobilization "non-depressive" rats remember painful stimulation and therefore they are not enter in the dark compartment during whole period of observation during testing session. Behavior of high immobilization "depressive" rats is not similar in passive avoidance camera; 50% of "depressive" rats, with long escape latency during training session (92±10 sec), remember painful stimulation during testing session and therefore they are not enter in the dark compartment during whole observation period. The remaining 50%, that are not differ significantly from the low immobility "non-depressive" rats by the latency of escape (5±1 sec) during training session, are not able to remember painful stimulation during testing session and therefore they enter in the dark compartment with shortest escape latency (6±1 sec). In conclusion, high immobility "depressive" rats perform passive avoidance declarative memory task at the chance level that is a direct indicator for the serious disturbances of declarative memory mechanisms in "depressive" rats selected in forced swim test according to the level of immobility.

Teaching Your Child to Fail

ERIC Educational Resources Information Center

Reeves, Diana

2014-01-01

Fear of failure starts early in life, and is common among high achievers. From their earliest years, many gifted children are successful in almost everything they try because they are under challenged, and paradoxically, become failure-avoidant. When parents always encourage their children to get the highest grade or to be "the best,"…

The Early Years: Navigating Natural Disasters

ERIC Educational Resources Information Center

Ashbrook, Peggy

2016-01-01

Keeping track of the weather is especially important in communities where severe weather endangers property and lives. Science education may mean talking with children about scary or tragic events. Although teachers should not avoid teaching about severe weather events, they can be sensitive to students' fears and stress by first asking families…

Avoidance from Thought Experiments: Fear of Misconception

ERIC Educational Resources Information Center

Ozdemir, Omer Faruk

2009-01-01

Two independent lines of research--mental simulations and thought experiments--provide strong arguments about the importance of perceptual modalities for the instructional practices in science education. By situating the use of mental simulations in the framework of thought experiments, this study investigated the nature and the role of mental…

Teaching in a Cold Environment.

ERIC Educational Resources Information Center

Ewert, Alan

Instructors who teach outdoors in an environment so cold as to cause injury must satisfy program objectives while avoiding cold injury to themselves and students, help students focus on learning instead of discomfort, and alleviate some students' intense fear of the cold. Dealing with the cold successfully requires a thorough knowledge of:…

Defensiveness in Communication: Its Causes, Effects, and Cures.

ERIC Educational Resources Information Center

Baker, William H.

1980-01-01

Analyzes defensiveness in communication as caused by an unwillingness to acknowledge and tolerate differences in others, a fear of change in ourselves, and a desire to avoid mental imbalance. It causes a deteriorating cycle between communicators but can be reduced by empathy, treatment of fellow communicators as equals, and genuineness. (JMF)

When Fear Ruled: Rethinking the Cuban Missile Crisis.

ERIC Educational Resources Information Center

Paterson, Thomas G.

1995-01-01

Provides an insightful look at the administrative and negotiative processes that accompanied the 1962 Cuban missile crisis. Although John F. Kennedy and Nikita Khrushchev both worked to avoid nuclear war, the stress and exhaustion of the negotiating process created serious blunders. Eventually both sides backed away from nuclear annihilation. (MJP)

Group Counseling for Overweight and Depressed College Women: A Comparative Evaluation.

ERIC Educational Resources Information Center

McNamara, Kathleen

1989-01-01

Behavioral and cognitive-behavioral group programs for weight control were effective among 32 college women in reducing weight and alleviating depressed mood, fear of negative evaluations, and social avoidance and distress. Addition of cognitive restructuring component failed to improve efficacy of behavioral weight control program even on…

Out of School: A Phenomenological Exploration of Extended Non-Attendance

ERIC Educational Resources Information Center

Baker, Matt; Bishop, Felicity L.

2015-01-01

The concept of "extended non-attendance" ("school phobia" or "school refusal") was distinguished from truancy early in the twentieth century, and refers to children who fear school and avoid attending. Despite much subsequent research, outcomes for those affected remain poor, and their voices remain largely absent…

A Lawyer-Therapist Team as Mediator in a Marital Crisis.

ERIC Educational Resources Information Center

Wiseman, Janet Miller; Fiske, John A.

1980-01-01

Whether the union is jeopardized by disappointment, fear of not achieving satisfaction in life, or other problems, the couple in crisis may turn to divorce as the lesser evil. The mediation process is of potential value to those couples who may want to avoid protracted, painful lawsuits. (Author)

Agoraphobia in a Rehabilitation Medicine Setting: A Case Report.

ERIC Educational Resources Information Center

Kaplan, Steven P.

1987-01-01

Agoraphobia is a pervasive constellation of fears and avoidance behaviors relating to open spaces, crowds, being alone, and other everyday situations. Presents the case of a client with agoraphobia on a medical rehabilitation unit. Outlines psychological interventions, giving discharge and follow-up status. Literature review focused on possible…

Flipping the Mindset: Reframing Fear and Failure to Catalyze Development

ERIC Educational Resources Information Center

Boyd, Diane E.; Baudier, Josie; Stromie, Traci

2015-01-01

Despite the attempts to target success and predisposition to taking risks to promote innovation, sometimes educational developers encounter moments where they fail to meet expectations set forth--by their institutions, colleagues, or themselves. Attempts to avoid potential failures can stymie the creative process, preventing them from meeting…

The Growth of Economic Studies at Cambridge: 1776-1860.

ERIC Educational Resources Information Center

Rashid, Salim

1980-01-01

Traces the resistance toward establishing an economics curriculum at Cambridge University from 1776 to 1860. Complex reasons include inertia, low intellectual standards, fear of being considered partisan, and avoidance of change during good times. The eventual introduction of economics was achieved only when wholesale reforms were enacted within…

Reactions of religious fundamentalists to taboo images and words.

PubMed

Bates, Larry W; Hudiburg, Richard A; Lauderdale, Elizabeth P; Castillo, Joseph R

2013-08-01

Some view religious fundamentalism as inclusive of fear of the world as a dangerous place. Fundamentalists are known to have extensive taboo lists, but research concerning their reactions to taboo stimuli is sparse. If fear is a basic component of fundamentalism, then reactions to taboo stimuli should be somewhat similar to common fear reactions, including subjective appraisal of discomfort, psychophysiological arousal, cognitive interference, and behavioral avoidance. The current research addressed some of these questions with three studies to examine subjective discomfort to religiously-taboo and religiously-neutral words and photographs (N = 160), physiological arousal to these same photographs (N = 129), and attentional bias on a modified Stroop test of these same words (N = 182). Although subjective appraisals of discomfort to taboo words and photographs among fundamentalists were confirmed, this research did not find that physiological responses or cognitive interference to taboo stimuli were elevated in those scoring high in religious fundamentalism.

Positive and negative affect, life satisfaction, and coping with stress by attachment styles in Turkish students.

PubMed

Deniz, M Engin; Işik, Erkan

2010-10-01

The purpose was to investigate positive and negative affect, life satisfaction, and coping with stress in relation to attachment styles. Undergraduate students (N=421) completed the Relationship Scales Questionnaire, the Positive and Negative Affect Scale, the Satisfaction With Life Scale, and the Coping with Stress Scale. Results indicated that secure attachment style was the unique predictor of positive affect while fearful and preoccupied attachment styles significantly predicted negative affect. Regarding life satisfaction, a positive correlation with secure attachment style and a negative correlation with fearful and preoccupied styles were seen. However, the unique predictor of life satisfaction was preoccupied attachment style. In terms of coping with stress, there was no significant association between attachment variables and avoidance coping style, but significant links were observed between problem-focused coping and dismissing, and fearful and preoccupied attachment styles.

[Diagnosis and therapy of anxiety disorders].

PubMed

Wacker, H R

1997-07-01

Anxiety disorders may be encountered by the medical practitioner in the form of phobias, panic disorder or generalized anxiety disorder. A phobia is characterized by a strong, irrational fear of a given object or situation, often resulting in avoidance behavior. Phobic patients usually respond well to cognitive behavioral therapy. Panic disorder, which is distinguished by recurring, unexpected attacks of fear not bound to particular situations, may also be treated with cognitive behavioral therapy and/or with clomipramin, benzodiazepines or selective serotonin reuptake inhibitors. Patients with generalized anxiety disorder, the main symptom of which is a persistent, free-floating fear over a period of at least several months, may be helped through relaxation techniques, counseling and/or medication with low doses of sedating tricyclic compounds or short-term treatment with benzodiazepines. This article will describe anamnestic findings and the results of clinical examinations of patients with anxiety disorders. Factors to be considered in differential diagnosis will be discussed.

Acquisition of CS-US contingencies during Pavlovian fear conditioning and extinction in social anxiety disorder and posttraumatic stress disorder.

PubMed

Rabinak, Christine A; Mori, Shoko; Lyons, Maryssa; Milad, Mohammed R; Phan, K Luan

2017-01-01

Fear-based disorders, like social anxiety disorder (SAD) and posttraumatic stress disorder (PTSD), are characterized by an exaggerated fear response and avoidance to trigger cues, suggesting a transdiagnostic mechanism of psychopathology. Current theories suggest that abnormalities in conditioned fear is a primary contributor to the pathophysiology of these disorders. The primary goal of this study was to compare acquisition of conditioned stimulus (CS) and aversive unconditioned stimulus (US) contingencies during fear learning and extinction in individuals with SAD and PTSD. In a standard Pavlovian fear conditioning-extinction paradigm we measured subjective US expectancy ratings to different CSs in patients with SAD (n=16) compared to patients with PTSD (n=13) and healthy controls (n=15) RESULTS: Both patient groups (SAD, PTSD) acquired differential conditioning between a CS that predicted US (CS+) and a CS that never predicted the US (CS-), however, both groups reported an increased expectancy that the US would occur following the CS-. Additionally, the PTSD group overestimated that the US would occur in general. Neither patient group showed evidence of successful extinction of the CS+-US contingency nor differentiated their expectation of US occurrence between the CS+ and CS- during extinction learning. Group sample sizes were small and we did not include a trauma-exposed group without PTSD CONCLUSIONS: Both SAD and PTSD generalize expectations of an aversive outcome across CSs, even when a CS never signals an aversive outcome and PTSD may tend to over-expect threat. Fear learning and extinction abnormalities may be a core feature underlying shared symptoms across fear-based disorders. Copyright © 2016 Elsevier B.V. All rights reserved.

Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research

PubMed Central

McMurtry, C. Meghan; Taddio, Anna; Noel, Melanie; Antony, Martin M.; Chambers, Christine T.; Asmundson, Gordon J. G.; Pillai Riddell, Rebecca; Shah, Vibhuti; MacDonald, Noni E.; Rogers, Jess; Bucci, Lucie M.; Mousmanis, Patricia; Lang, Eddy; Halperin, Scott; Bowles, Susan; Halpert, Christine; Ipp, Moshe; Rieder, Michael J.; Robson, Kate; Uleryk, Elizabeth; Votta Bleeker, Elizabeth; Dubey, Vinita; Hanrahan, Anita; Lockett, Donna; Scott, Jeffrey

2016-01-01

Abstract Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided. PMID:27007463

Strain dependent effects of conditioned fear in adult C57Bl/6 and Balb/C mice following postnatal exposure to chlorpyrifos: relation to expression of brain acetylcholinesterase mRNA

PubMed Central

Oriel, Sarit; Kofman, Ora

2015-01-01

Following reports of emotional psychopathology in children and adults exposed to organophosphates, the effects of postnatal chlorpyrifos (CPF) on fear-conditioning and depression-like behaviors were tested in adult mice. Concomitant changes in expression of mRNA for synaptic and soluble splice variants of acetylcholinesterase (AChE) were examined in mouse pups and adults of the Balb/C and C57Bl/6 (B6) strains, which differ in their behavioral and hormonal stress response. Mice were injected subcutaneously with 1 mg/kg CPF on postnatal days 4–10 and tested as adults for conditioned fear, sucrose preference, and forced swim. Acetylcholinesterase activity was assessed in the brains of pups on the first and last day of treatment. Expression of soluble and synaptic AChE mRNA was assessed in brains of treated pups and fear-conditioned adults using real-time PCR. Adult Balb/C mice exposed postnatally to CPF showed exacerbated fear-conditioning and impaired active avoidance. Adult B6 mice exposed postnatally to CPF showed a more specific fear response to tones and less freezing in the inter-tone intervals, in contrast to the vehicle-pretreated mice. Chlorpyrifos also attenuated sweet preference and enhanced climbing in the forced swim test. Chlorpyrifos-treated mice had increased expression of both synaptic and readthrough AChE transcripts in the hippocampus of Balb/C mice and decreased expression in the amygdala following fear-conditioning. In conclusion, postnatal CPF had long-term effects on fear and depression, as well as on expression of AChE mRNA. These changes may be related to alteration in the interaction between hippocampus and amygdala in regulating negative emotions. PMID:25972795

Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research.

PubMed

McMurtry, C Meghan; Taddio, Anna; Noel, Melanie; Antony, Martin M; Chambers, Christine T; Asmundson, Gordon J G; Pillai Riddell, Rebecca; Shah, Vibhuti; MacDonald, Noni E; Rogers, Jess; Bucci, Lucie M; Mousmanis, Patricia; Lang, Eddy; Halperin, Scott; Bowles, Susan; Halpert, Christine; Ipp, Moshe; Rieder, Michael J; Robson, Kate; Uleryk, Elizabeth; Votta Bleeker, Elizabeth; Dubey, Vinita; Hanrahan, Anita; Lockett, Donna; Scott, Jeffrey

2016-04-01

Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.

Furoxans (Oxadiazole-4 N-oxides) with Attenuated Reactivity are Neuroprotective, Cross the Blood Brain Barrier, and Improve Passive Avoidance Memory.

PubMed

Horton, Austin; Nash, Kevin; Tackie-Yarboi, Ethel; Kostrevski, Alexander; Novak, Adam; Raghavan, Aparna; Tulsulkar, Jatin; Alhadidi, Qasim; Wamer, Nathan; Langenderfer, Bryn; Royster, Kalee; Ducharme, Maxwell; Hagood, Katelyn; Post, Megan; Shah, Zahoor A; Schiefer, Isaac T

2018-05-07

Nitric oxide (NO) mimetics and other agents capable of enhancing NO/cGMP signaling have demonstrated efficacy as potential therapies for Alzheimer's disease. A group of thiol-dependent NO mimetics known as furoxans may be designed to exhibit attenuated reactivity to provide slow onset NO effects. The present study describes the design, synthesis, and evaluation of a furoxan library resulting in the identification of a prototype furoxan, 5a, which was profiled for use in the central nervous system. Furoxan 5a demonstrated negligible reactivity toward generic cellular thiols under physiological conditions. Nonetheless, cGMP-dependent neuroprotection was observed, and 5a (20 mg/kg) reversed cholinergic memory deficits in a mouse model of passive avoidance fear memory. Importantly, 5a can be prepared as a pharmaceutically acceptable salt and is observed in the brain 12 h after oral administration, suggesting potential for daily dosing and excellent metabolic stability. Continued investigation into furoxans as attenuated NO mimetics for the CNS is warranted.

Social Anxiety Scale for Adolescents: factorial invariance across gender and age in Hispanic American adolescents.

PubMed

La Greca, Annette M; Ingles, Candido J; Lai, Betty S; Marzo, Juan C

2015-04-01

Social anxiety is a common psychological disorder that often emerges during adolescence and is associated with significant impairment. Efforts to prevent social anxiety disorder require sound assessment measures for identifying anxious youth, especially those from minority backgrounds. We examined the factorial invariance and latent mean differences of the Social Anxiety Scale for Adolescents (SAS-A) across gender and age groups in Hispanic American adolescents (N = 1,191; 56% girls; 15-18 years) using multigroup confirmatory factor analyses. Results indicated that the factorial configuration of the correlated three-factor model of the SAS-A was invariant across gender and age. Analyses of latent mean differences revealed that boys exhibited higher structured means than girls on the Social Avoidance and Distress-General (SAD-General) subscale. On all SAS-A subscales, Fear of Negative Evaluation, Social Avoidance and Distress-New, and SAD-General, estimates of the structured means decreased with adolescent age. Implications for further research and clinical practice are discussed. © The Author(s) 2014.

The "double life" of bulimia: patients' experiences in daily life interactions.

PubMed

Pettersen, Gunn; Rosenvinge, Jan H; Ytterhus, Borgunn

2008-01-01

This qualitative study, using interviews with 38 subjects, explored how and why they conceal bulimic symptoms and the understanding of concealing in terms of social interaction. A "double life" was described as a dichotomy between being active and outgoing versus performing shameful bulimic behaviors and constantly living with fear of stigmatization, and striving against exposure. Concealing was well planned to avoid such fear, and to preserve dignity. Bulimia may be understood as volitional exertion of interaction control, not just as a result of poor impulse regulation. Understanding the meaning of secrecy and "double life" may facilitate help seeking behavior and guide treatment.

Inhibition of Vicariously Learned Fear in Children Using Positive Modeling and Prior Exposure

PubMed Central

2015-01-01

One of the challenges to conditioning models of fear acquisition is to explain how different individuals can experience similar learning events and only some of them subsequently develop fear. Understanding factors moderating the impact of learning events on fear acquisition is key to understanding the etiology and prevention of fear in childhood. This study investigates these moderators in the context of vicarious (observational) learning. Two experiments tested predictions that the acquisition or inhibition of fear via vicarious learning is driven by associative learning mechanisms similar to direct conditioning. In Experiment 1, 3 groups of children aged 7 to 9 years received 1 of 3 inhibitive information interventions—psychoeducation, factual information, or no information (control)—prior to taking part in a vicarious fear learning procedure. In Experiment 2, 3 groups of children aged 7 to 10 years received 1 of 3 observational learning interventions—positive modeling (immunization), observational familiarity (latent inhibition), or no prevention (control)—before vicarious fear learning. Results indicated that observationally delivered manipulations inhibited vicarious fear learning, while preventions presented via written information did not. These findings confirm that vicarious learning shares some of the characteristics of direct conditioning and can explain why not all individuals will develop fear following a vicarious learning event. They also suggest that the modality of inhibitive learning is important and should match the fear learning pathway for increased chances of inhibition. Finally, the results demonstrate that positive modeling is likely to be a particularly effective method for preventing fear-related observational learning in children. PMID:26653136