Behaviour research and therapy
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Recent exploratory [Taylor, S., Kuch, K., Koch, W. J., Crockett, D. J., & Passey, G. (1998). ⋯ The hierarchical four-factor model (comprising four first-order factors corresponding to reexperiencing, avoidance, numbing, and hyperarousal all subsumed by a higher-order general factor) provided the best overall fit to the data; although, all models met some standards specified for good model fit. More research is needed to establish the dimensional nature of PTSD symptoms and to assess whether identified dimensions differ as a function of the trauma experience. Implications for assessment, diagnosis, and treatment are also discussed.
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Anxiety sensitivity (AS) plays an important role in the cognitive, affective and behavioral profiles of patients with chronic pain related to musculoskeletal injury. However, investigators have not considered whether these findings extend to patients with other classes of chronic pain. The primary purpose of this investigation was to address this issue in 72 patients with recurring headaches who completed a self-report questionnaire inventory during a treatment visit to an outpatient neurology clinic. ⋯ Lifestyle changes attributed to headache were, on the other hand, predicted by headache severity, physiological and cognitive anxiety and escape/avoidance behavior. These results provide further evidence of the important association between AS and fear responses of patients with chronic pain syndromes. Implications and future directions are discussed.
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Rachman's (1980) analysis [Rachman, S. (1980). Emotional processing. Behaviour Research and Therapy, 18, 51-60] of emotional processing is extended and applied to the prevention of relapse and recurrence in depression. ⋯ Only the last of these facilitates emotional processing; the second may prevent effective emotional processing and perpetuate depression by ruminative, conceptually dominated processing. This analysis suggests a further strategy to prevent relapse, in addition to modifying depressogenic schematic models, by teaching recovered depressed patients skills to switch processing modes by intentional redeployment of attention. Results of a recent trial of mindfulness-based cognitive therapy support the effectiveness of this novel alternative strategy.
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Fear of anxiety symptoms, or anxiety sensitivity (AS), has been extensively studied in anxiety disorders and more recently has been linked to other psychopathological conditions including pain. Asmundson and colleagues have suggested that AS may act as a risk factor for chronic pain and several studies have demonstrated an association between AS, avoidance behaviors and pain. The present study assessed whether AS levels would be predictive of pain and anxiety during a brief pain induction task. ⋯ Diagnostic status and AS were significantly predictive of pain and anxiety during the cold pressor task. Moreover, AS appears to mediate the relationship between diagnostic status and pain. However, AS appears to be only indirectly associated with pain through its contribution to anxiety.
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In this reply to Bissett and Hayes (this issue) and Staats (this issue) we address critical comments in response to our initial proposal and highlight points of agreement. The overall thesis of our reply is that classification schemes based on nomothetic response covariation, such as DSM, complement, but do not substitute for, an idiographically-based functional analysis and behavioral assessment. In the context of our reply, we address the following primary concerns raised by Bissett, Hayes, and Staats: (a) we are essentially proposing the melding of two theoretically incongruent approaches, and that such a melding is inherently not viable or useful; (b) the behavior analytic approach cannot account for personality or psychological constructs; and (c) that categories based on topography do not have demonstrated treatment utility. We also discuss points of agreement with our respondents: (d) a theoretically-based descriptive classification system is required to ultimately advance clinical science, (e) the DSM personality disorder classification system, to remain viable, needs a stronger empirical base; and (f) that alternatives to DSM classification that more strongly emphasize behavioral principles are in need of development.