Showing papers by "Michelle G. Craske published in 2009"
TL;DR: The extant data help to define the features of responding that are shared across anxiety disorders, but are insufficient to justify revisions to the DSM nosology at this time.
Abstract: Initiated as part of the ongoing deliberation about the nosological structure of DSM, this review aims to evaluate whether the anxiety disorders share features of responding that define them and make them distinct from depressive disorders, and/or that differentiate fear disorders from anxious-misery disorders. The review covers symptom self-report as well as on-line indices of behavioral, physiological, cognitive, and neural responding in the presence of aversive stimuli. The data indicate that the anxiety disorders share self-reported symptoms of anxiety and fear; heightened anxiety and fear responding to cues that signal threat, cues that signal no threat, cues that formerly signaled threat, and contexts associated with threat; elevated stress reactivity to aversive stimuli; attentional biases to threat-relevant stimuli and threat-based appraisals of ambiguous stimuli; and elevated amygdala responses to threat-relevant stimuli. Some differences exist among anxiety disorders, and between anxiety disorders and depressive disorders. However, the differences are not fully consistent with proposed subdivisions of fear disorders vs. anxious misery disorders, and comparative data in large part are lacking. Given the high rates of co-morbidity, advances in our understanding of the features of responding that are shared across vs. unique to anxiety and depressive disorders will require dimensional approaches. In summary, the extant data help to define the features of responding that are shared across anxiety disorders, but are insufficient to justify revisions to the DSM nosology at this time.
475 citations
TL;DR: This investigation suggests that the OASIS is a valid instrument for measurement of anxiety severity and impairment in clinical samples and its brevity and applicability to a wide range of anxiety disorders enhance its utility as a screening and assessment tool.
274 citations
TL;DR: Computer‐assisted CBT programs provide a practice‐based system for disseminating evidence‐based mental health treatment in primary‐care settings while maintaining treatment fidelity, even in the hands of novice clinicians.
Abstract: Objectives: This article describes a computer-assisted cognitive behavioral therapy (CBT) program designed to support the delivery of evidenced-based CBT for the four most commonly occurring anxiety disorders (panic disorder, posttraumatic stress disorder, generalized anxiety disorder, and social anxiety disorder) in primary-care settings. The purpose of the current report is to (1) present the structure and format of the computer-assisted CBT program, and (2) to present evidence for acceptance of the program by clinicians and the effectiveness of the program for patients. Methods: Thirteen clinicians using the computer-assisted CBT program with patients in our ongoing Coordinated Anxiety Learning and Management study provided Likert-scale ratings and open-ended responses about the program. Rating scale data from 261 patients who completed at least one CBTsession were also collected Results: Overall, the program was highly rated and modally described as very helpful. Results indicate that the patients fully participated (i.e., attendance and homework compliance), understood the program material, and acquired CBT skills. In addition, significant and substantial improvements occurred to the same degree in randomly audited subsets of each of the four primary anxiety disorders (N 574), in terms of self ratings of anxiety, depression, and expectations for improvement. Conclusions: Computer-assisted CBT programs provide a
161 citations
TL;DR: The authors define CBT, examine treatment components, review treatment efficacy, and discuss the challenges of attrition, long-term follow-up, co-occurring/comorbid disorders, limited treatment comparisons, treatment mediators, and broader implementation.
154 citations
TL;DR: A one-factor model fitted each dataset well, which suggests that responses to positive and negative cues are related to the one construct, and item response theory analyses showed that the AMT is most precise for people who score low on memory specificity.
Abstract: The Autobiographical Memory Test (AMT) is used to assess the degree of specificity of autobiographical memory. The AMT usually contains cue words of both positive and negative valence, but it is unclear whether these valences form separate factors or not. Accordingly, confirmatory factor analysis assessed whether the AMT measures one overall factor, or whether different cue types are related to different factors. Results were consistent across three datasets (N = 333, N = 405, and N = 336). A one-factor model fitted each dataset well, which suggests that responses to positive and negative cues are related to the one construct. In addition, item response theory analyses showed that the AMT is most precise for people who score low on memory specificity. Implications for using the AMT with high-functioning samples are discussed.
100 citations
TL;DR: A computer-assisted CBT program is developed that guides both novice clinician and patient, thereby contributing to sustainability once the research is over, and a measurement based approach to treatment planning is incorporated using a web-based tracking system of patient status.
87 citations
TL;DR: It is proposed that preoccupation interferes with specific aspects of mental functioning, especially attention and responsivity to the environment, and impairs the mother’s parenting capacities and adversely affects mother-child interaction and child development.
Abstract: There is considerable evidence that maternal postnatal psychiatric disorder has an adverse influence on infant development. In attempting to examine the pathways of intergenerational transmission, mos
77 citations
TL;DR: A new statistical approach is offered for addressing content overlap, testing for disorder specific prediction and identifying facets of a broad personality trait, while indicating that content overlap does not largely explain the associations of neuroticism with psychopathology.
72 citations
TL;DR: Although at present the data do not warrant the utility of subtyping, further research aimed at patent gaps in the literature, including clearer operationalization of symptom subtypes, greater use of biological challenge paradigms and physiological and other more objective measures of fear and anxiety, may support the future designation of panic attack subtypes and their ultimate clinical utility.
Abstract: Background: Panic disorder is a heterogeneous disorder, comprising a variety of somatic, physiological, and cognitive symptoms during repeated panic attacks. As a result, considerable data have examined whether panic attacks may be classified into distinct diagnostic or functional subtypes. The aim of this study is to evaluate the existing literature regarding the validity of panic attack subtypes. Methods: This review focuses on data published since 2000, with the publication of DSM-IV-TR, augmented by replicated data published since 1980, with the publication of DSM-III and subsequently DSM-IV. Published reports evaluating empirical evidence for the validity of panic attack subtypes are reviewed. Results: Five sets of panic symptoms (respiratory, nocturnal, nonfearful, cognitive, and vestibular) have been shown to cluster together at varying degrees of consistency. However, none of these potential subtypes have been associated with sufficient and reliable external validation criteria indicative of functional differences. This apparent lack of findings may be related to methodological inconsistencies or limitations across the reviewed studies. Conclusions: Although at present the data do not warrant the utility of subtyping, further research aimed at patent gaps in the literature, including clearer operationalization of symptom subtypes, greater use of biological challenge paradigms and physiological and other more objective measures of fear and anxiety, and exploration of subtyping based on biological factors such as genetics, may support the future designation of panic attack subtypes and their ultimate clinical utility. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc.
65 citations
TL;DR: An approach for initial education of the patient and discussion about treatment, including provision of some simple cognitive behavioral therapy skills, based on motivational interviewing/brief intervention approaches previously used for substance use disorders.
Abstract: To address the difficulty of assessing and managing multiple anxiety disorders in the primary care setting, this article provides a simple, easy-to-learn, unified approach to the diagnosis, care management, and pharmacotherapy of the 4 most common anxiety disorders found in primary care: panic, generalized anxiety disorders, social anxiety disorders, and posttraumatic stress disorder. This evidence-based approach was developed for an ongoing National Institute of Mental Health-funded study designed to improve the delivery of evidence-based medication and psychotherapy treatment to primary care patients with these anxiety disorders. We present a simple, validated method to screen for the 4 major disorders that emphasizes identifying other medical or psychiatric comorbidities that can complicate treatment; an approach for initial education of the patient and discussion about treatment, including provision of some simple cognitive behavioral therapy skills, based on motivational interviewing/brief intervention approaches previously used for substance use disorders; a validated method for monitoring treatment outcome; and an algorithmic approach for the selection of initial medication treatment, the selection of alternative or adjunctive treatments when the initial approach has not produced optimal results, and indications for mental health referral.
53 citations
TL;DR: The hypothesis that the observed abnormality may be involved in the enhanced perception of bladder signals associated with interstitial cystitis/painful bladder syndrome is supported.
TL;DR: These results suggest that adolescents with high levels of N show greater sensitivity to contexts intermediately associated with threat, compared with groups at risk for anxiety and depressive disorders.
TL;DR: Patients who were non-white, had higher anxiety sensitivity, and higher overall phobic avoidance at baseline were less likely to show clinical improvement at 12 months and a greater understanding of these predictors may help clinicians identify who is at greatest risk for persistent panic-related symptoms and to plan the intensity of interventions accordingly.
Abstract: This study's aim was to prospectively examine and identify a model of demographic, clinical, and attitudinal variables that impact improvement among patients with panic disorder. Subjects were 232 primary care patients meeting criteria for DSM-IV panic disorder. Eligible patients were randomly assigned to a collaborative care intervention or to treatment as usual. Assessments occurred at 3-month intervals during the course of 1 year. In final multivariate logistic regression models, patients with higher anxiety sensitivity and higher neuroticism scores at baseline were less likely to show clinical improvement (using a criterion of 20 or less on the Anxiety Sensitivity Index) at 3 months. Those who were non-white, had higher anxiety sensitivity, and higher overall phobic avoidance at baseline were less likely to show clinical improvement at 12 months. A greater understanding of these predictors may help clinicians identify who is at greatest risk for persistent panic-related symptoms and to plan the intensity of interventions accordingly.
TL;DR: The first to evaluate the DAS-A factor structure in an adolescent population of 542 high school juniors and the first to examine a hierarchical model supporting the existence of a hierarchical structure is evaluated.
Abstract: Form A of the Dysfunctional Attitude Scale (DAS-A), a self-report measure of depressive beliefs, is widely used to test Beck's cognitive model of depression. The present study is the first to evaluate the DAS-A factor structure in an adolescent population of 542 high school juniors and the first to examine a hierarchical model. Findings support the existence of a hierarchical structure consisting of two conceptually meaningful group factors (Dysfunctional Attitudes About Achievement and Dysfunctional Attitudes About Needing Approval), a method factor consisting of reverse-worded items, and a general factor, which accounts for 65% of the variance in total scores. The general factor is related to sociotropy, autonomy, and neuroticism, whereas the Dysfunctional Attitudes About Achievement and Dysfunctional Attitudes About Needing Approval factors demonstrate convergent and discriminant validity with respect to autonomy and sociotropy. The structure displays partial metric invariance in female and male studen...
TL;DR: Findings suggest that when primed by everyday worries and concerns, individuals prone to preoccupation may have their capacity to recall emotion‐related interpersonal information compromised.
Abstract: Background: The aim of this pilot study was to examine whether priming preoccupation (rumination) in healthy participants adversely affects the processing of interpersonal information. Methods: Sixty female undergraduates with moderate or marked preoccupation proneness (selected on the basis of their high preoccupation on eating, shape, and weight issues) were randomized to receive either a general preoccupation prime, a standardized preoccupation prime, or a control prime. Following the prime, participants watched an 8-min videotape of a family interaction and then were asked free recall questions about the tape. Results: Participants who received the general preoccupation prime scored lower than the other two groups in response to free recall questions regarding emotion-related topics. Conclusions: These findings suggest that when primed by everyday worries and concerns, individuals prone to preoccupation may have their capacity to recall emotion-related interpersonal information compromised. Depression and Anxiety, 2009. © 2008 Wiley-Liss, Inc.