Clark and Wells (1995) argued that individuals with social phobia attend solely towards internal threat, whereas Beck, Emery and Greenberg (1985) and Rapee and Heimberg (1997) proposed that social phobics attend towards internal and external threat cues, during a social encounter. With this in mind, the aim was to investigate attentional processing in social anxiety and social phobia using the dot-probe task. Findings depend in part on which aspects of social anxiety are measured and used to select groups, therefore an exploration of the psychometric properties of the Fear of Negative Evaluation (FNE: Watson & Friend, 1969) and the Social Avoidance and Distress (SAD: Watson & Friend, 1969) scales was undertaken. Experiment one investigated conscious processing in high (n = 40) and low (n = 40) socially anxious participants. The results showed that the high socially anxious attended towards negative evaluation words (non-evaluative condition) and somatic sensation words (social-evaluative condition), compared to the low socially anxious. Experiment two explored pre-attentive and conscious attentional processing. A pre-attentional bias towards physical threat words was evident in the high socially anxious (n = 41), compared to the low socially anxious participants (n = 41), under social-evaluative conditions. There were no more significant findings. Experiment three investigated conscious attentional processing in generalised social phobics (n = 16) and low anxious controls (n = 16). The results revealed that individuals with generalised social phobia attended towards the physical threat words, compared to the matched controls. Study four examined the psychometric characteristics of the FNE and SAD. The FNE comprised of a fear of negative evaluation factor and the SAD a social avoidance and distress and a fear of new situations and strangers factor. The findings overall showed that attentional biases in social anxiety and social phobia can be specific to certain aspects of threat and modified by changes in level and cause of state anxiety.

Recent research examining the 'yips' has focused a great deal on the mechanisms underpinning the experience in golf (McDaniel, Shain & Cummings, 1989). The research has generally shown that the 'yips' are a performance problem which lie on a continuum where choking (anxiety related) and dystonia symptoms anchor the extremes. The primary aim of this thesis was to examine the 'yips' problem across a range of sports skills, assessing the physical and psychological symptoms experienced, and the potential underlying mechanisms. A further aim, was to assess whether the 'yips' were the same problem independent of sport-type, or something entirely different. Study 1 examined the 'yips' from a broad perspective, using a mixed methods survey approach (Teddlie & Tashakorri, 2003). The study illustrated that the predominant sport skills affected by the 'yips' are golf putting, the darts throw and the cricket bowling action. The findings suggested that the 'yips' result in physical disruptions which occur during skill execution. Furthermore, the study indicated that, across sports, similar psychological symptoms emerged. Study 2 used a Grounded Theory (Strauss & Corbin, 1990) based approach to guide sampling, data collection and analysis. Individuals, independent of their sport, displayed perfectionist, obsessional and self conscious characteristics. In addition, all of the participants had experienced a significant life event at or around the time the 'yips' started. Recent movement disorder research had reported similar findings which may suggest that similar causal factors operate for focal dystonia and the 'yips' (Schweinfurth et al., 2002). Once individuals had experienced the initial 'yip', it appeared that participants would try and 'reinvest' in the knowledge base, and that they would obsessionally think about what had happened. It was suggested that individuals may convert the psychological pain experienced during that event into physical symptoms through a process of conversion (Baker & Humblestone, 2005), thus resulting in the 'yip'. Research has illustrated that damage to the basal ganglia has resulted in a wide range of dysfunctions in both emotions and motor behaviour (Lim et al., 2001). Future research should look to examine the impact of the significant life event has on the function of the basal ganglia. Study 3 used a quantitative approach, to assess whether individuals with the 'yips' displayed higher levels of perfectionism, obsessional thinking and reinvestment, than a matched control. The research suggests that those who experience the 'yips' have elevated levels of maladaptive perfectionism, obsessional thinking and self-consciousness compared with controls. These findings support research examining focal dystonia (Jabusch & Altenumuller, 2004) and the 'yips' (McDaniel et al., 1989). The final aim of the thesis attempted to establish a psychological intervention strategy that could aid performers who experience the 'yips'. The research used a novel form of intervention in the form of the Emotional Freedom Technique (Craig, 1995). The aim was to test whether the intervention was successful rather than the underpinning mechanisms of the process. The intervention was aimed at the events which occurred prior to the 'yips' to assess whether physical symptoms subsided, and performance returned to normality. In the two case studies illustrated, the intervention appeared to have success at 4 weeks and 6 months postintervention, therefore adding tentative support that the 'yips' may be caused by psychologically significant life events. It would appear that the 'yips' are a psychogenic movement disorder. Future research should look to understand the relationship between perfectionism, obsessional thinking, self-consciousness, life events and the development of the 'yips'. Furthermore, research should combine multi-disciplinary knowledge to explore the 'yips' to gain a more holistic understanding of the problem from a psychological and neurological perspective.

Socially anxious individuals often report considerable anticipatory anxiety. A recent cognitive model of social phobia (Clark & Wells, 1995) has suggested that while anticipating a social situation, socially anxious people engage in four biased cognitive processes. First, they recall and dwell on past perceived failures. Second, they construct negative observer-perspective images of how they think they may appear toothers. Third, they focus their attention on their bodily sensations and negative thoughts. Finally, they use their observed bodily sensations, negative thoughts and self-constructed images to predict how poorly they will perform in the anticipated social situation. These hypothesised processes were investigated in two studies. In the first study (Experiment 1), 20 high and 20 low socially anxious individuals were given a semi-structured interview which focussed on their mental processes during periods of anticipatory anxiety. The results of the interview were broadly consistent with the four hypotheses and provided additional data about the nature of functional and dysfunctional anticipatory processing. In a second study (Experiment 2), the effects of dysfunctional anticipatory processing on levels of social anxiety and confidence were investigated. Twenty high and 20 low socially anxious individuals engaged in either the dysfunctional anticipatory processes identified in study one or a distraction task prior to giving a video-taped speech. The results showed that individuals who engaged in dysfunctional anticipatory processing prior to giving the speech, felt more anxious but not less confident before and during the speech than individuals who had engaged in the distraction task. The results of the two studies are discussed in relation to the cognitive model of social phobia (Clark & Wells, 1995) and limitations of the experimental designs are highlighted. It is argued that research from worry may provide an explanation for the maintenance of dysfunctional anticipatory processing in socially anxious individuals,and _a theoretical approach to the maintenance of dysfunctional anticipatory processing in social anxiety is outlined which integrates the findings from the present study with other research findings. Finally, the implications of the present findings for the treatment of anticipatory social anxiety are discussed, and recommendations for future research are made.

Generalised anxiety disorder (GAD) is a chronic condition that has a significant impact on the lives of its sufferers. Although the validity of the diagnosis has been the subject of much controversy in psychiatric circles, the prevalence and economic impact of this syndrome warrants further study. Such research has hitherto been generally lacking. In the interests of furthering research, and of providing a tool to evaluate new progressions in the treatment of GAD, the present thesis embarks on the development of a new scale. The Generalised Anxiety Disorder Inventory (GADI) seeks to provide a simple self-completion measure of GAD, which can be used to track the severity of the condition over time. Four studies are reported which document the initial stages of the development and validation of the GADI. Study One describes the derivation of a 22-item scale from an initial pool of possible items. Studies Two and Three describes initial reliability and validity statistics in two non-psychiatric populations. Study Four reports the same reliability and validity analyses in a psychiatric outpatient sample. It is concluded that the GADI performs satisfactorily in the analyses performed in the course of this thesis. However, in order to realise the scale's full potential a number of additional, longitudinal studies are required. The thesis concludes with suggested methodologies for these, and the news of a planned multi-centre collaboration for their implementation.

The literature review critically appraises seven randomly controlled trials that investigate the effectiveness of self help approaches in relation to the management of anxiety based disorders. Clearly there is a need for further trials to focus much more in depth on different aspects of the self help packages assessed. There is also a very real need to link the mixed outcome data to a theoretical knowledge base that may begin to explain the mechanisms that underpin the results.

Research exploring how people change across treatment has identified subpopulations of individuals that follow similar patterns of change across time. Empirical findings indicate that early change might be key in overall treatment benefit. One particular pattern of early change, Sudden Gains (SG), has received much attention in the depression literature in recent years. However, few studies have investigated SG in anxiety disorders or indeed in routine clinical practice. Furthermore, two key cognitive constructs have been suggested as relevant in the experience of SG, attributional style, and level of efficacy expectancy, yet no empirical research to date has investigated them together in predicting SG. The objectives of this project were three-fold: 1) to explore patterns of anxiety change in routine clinical practice using a relatively new statistical approach; 2) to identify if SG occur in anxiety in routine practice and if so, to explore the contributing role of attributional style and efficacy expectancy; and 3) to explore if these two constructs fluctuate across treatment and if specific treatment strategies were associated with this. To address these objectives this project used a prospective and retrospective longitudinal design and a singe case experimental design. In line with the hypotheses SG were identified in the sample, these were characterised by high levels of reversal of gains, similar to other routine practice research in this area. The cognitive variables were not found to predict SG. Four different patterns of change were identified that differed in response to treatment. Results indicated that exploring patterns of change in routine practice might have specific clinical implications in exploring effectiveness of treatments for different subpopulations of individuals. In addition the finding of a non-changing cluster pattern highlighted the importance of future research to inform clinical understanding of individuals who do not respond to treatment.

A large proportion of United Kingdom (UK) residents are now travelling abroad. The pre-travel consultation provides a good opportunity for clinicians to educate travellers about the risks involved with travel, and prevention strategies which they could utilize. Adherence to health travel advice prevents travel-related illness and reduces the risk of contracting infectious diseases. It is therefore important to assess whether health travel advice is retained post consultation. Anxiety and, specifically, anxiety about receiving a vaccination, could influence a traveller's ability to recall health advice. The present study aimed to investigate whether anxiety and, more specifically, injection anxiety can predict recall of health information following a travel clinic consultation. In addition, it also aimed to provide further information on the prevalence of injection anxiety in a travel clinic setting in the UK, as this has not been explored previously. Participants were recruited from two fee-paying travel clinics which they were attending for pre-travel advice and vaccinations. They completed a number of self-report measures exploring injection anxiety, state anxiety, and psychological and physical reactions to blood tests and injections. A recall questionnaire, designed for the study, was completed post consultation to assess recall of health information. Analysis of the data revealed that injection anxiety did not account for variance in recall ability. The prevalence rate of injection anxiety was found to be 39%, higher than previous studies completed outside the UK. The recall of information varied, and for the majority of participants not all information was retained post consultation. The implications for clinical practice are discussed and suggestions for future research are considered.

No description available.

Social anxiety disorder (SAD) in adolescents is associated with significant impairment in functioning and debilitating long-term consequences. Onset of the disorder is typically in young adolescence. Evidence suggests that young people with SAD have deficits in social competence, and there is preliminary evidence to suggest poorer mental state reasoning (MSR), although well-controlled studies focussing on adolescents are scarce. Social skills training (SST) is a component of several treatments for SAD, but the effectiveness of SST is unclear. The review paper summarises the evidence base for social skill (SS) deficits in adolescent SAD, critically evaluates the literature on SST, and highlights similarities and differences between the currently employed treatment protocols. The review concluded that there is significant overlap in the SS deficits that existing treatments target; however, there is also a wide variation in the assessment of SS. In the studies that measured SS, results suggest that SST is an effective treatment for improving SS in adolescents with SAD, although follow up data are limited. The empirical paper investigates social competence and MSR in a sample of typically-developing adolescents aged 11 to 16. A large number of adolescents were screened for social anxiety and experimental groups of high (HSA) and low (LSA) levels of symptoms were formed. Participants completed experimental testing, and parent-report measures were obtained.

This thesis comprises a literature review and empirical study relating to Attentional Bias Modification Training (ABMT) and Generalised Anxiety Disorder (GAD). Following a general introduction of GAD, the literature review explores the cognitive models of GAD that place an emphasis on attentional bias. These models propose attentional bias as a key factor in developing and maintaining GAD. The dot probe and emotional stroop task have demonstrated empirical evidence of the relationship between attentional bias and GAD. ABMT represents a new paradigm for testing the relationship between attentional bias and GAD. ABMT uses contingency training to implicitly modify attentional bias to either increase vigilance to threat or avoid threat stimuli. ABMT represents a relatively novel treatment for GAD. Research that has explored the effectiveness of ABMT in treating GAD is discussed. Based on a critical evaluation of the current evidence base, there is emerging evidence to suggest that ABMT does represent a novel treatment for GAD and future research questions are suggested. The empirical paper investigates the effectiveness of ABMT in training an attentional bias from threat vigilance towards threat avoidance in a student population. Following training, symptoms of GAD were induced through the use of 7.5% CO2 challenge to evaluate the prophylactic effects of ABMT, compared to an active relaxation control group. The results of the study show that ABMT significantly changed attentional bias in the expected direction. The CO2 inhalation effectively induced anxiety across all participants. However, ABMT did not attenuate anxiety following the CO2 challenge. Correlations within the ABMT group demonstrated a relationship with attentional bias and anxiety as measured by physiological responses. The results of the study are discussed in relation to theoretical models and empirical research. Clinical implications of the study are considered and suggestions of future research as a result of the findings are also proposed.