A growing body of literature suggests that Virtual Reality is a successful tool for exposure therapy for anxiety disorders. Virtual Reality (VR) researchers posit the construct of presence, interpreting an artificial stimulus as if it were real, as the mechanism that enables anxiety to be felt during virtual reality exposure therapy (VRE). However, empirical studies on the relation between presence and anxiety in VRE have yielded mixed findings. The current study tested the following hypotheses 1) Presence is related to in session anxiety and treatment outcome; 2) Presence mediates the extent that pre-existing (pre-treatment) anxiety is experienced during exposure with VR; 3) Presence is positively related to the amount of phobic elements included within the virtual environment. Results supported presence as the mechanism by which anxiety is experienced in the virtual environment as well as a relation between presence and the phobic elements, but did not support a relation between presence and treatment outcome

A growing body of literature suggests that Virtual Reality is a successful tool for exposure therapy for anxiety disorders. Virtual Reality (VR) researchers posit the construct of presence, interpreting an artificial stimulus as if it were real, as the mechanism that enables anxiety to be felt during virtual reality exposure therapy (VRE). However, empirical studies on the relation between presence and anxiety in VRE have yielded mixed findings. The current study tested the following hypotheses 1) Presence is related to in session anxiety and treatment outcome; 2) Presence mediates the extent that pre-existing (pre-treatment) anxiety is experienced during exposure with VR; 3) Presence is positively related to the amount of phobic elements included within the virtual environment. Results supported presence as the mechanism by which anxiety is experienced in the virtual environment as well as a relation between presence and the phobic elements, but did not support a relation between presence and treatment outcome

Obsessive Compulsive Disorder (OCD) is classified as an anxiety disorder characterized by distressing persistent unwanted ideas or impulses (obsessions) and urges and/or compulsion to do something to relieve the associated anxiety caused by the obsession. The thematic content of the obsessions are highly variable, ranging from symmetry, contamination to aggressive concerns. Compulsions tend to be linked to the obsessions, but can also be idiosyncratic to the intrusive thought. According to the cognitive model, Obsessive-compulsive disorder (OCD) is maintained by various belief factors such as an inflated sense of responsibility, overestimation of threat and the over-control of thoughts. Despite much support for this hypothesis, there is a lack of specificity. This series of studies sought to determine the relationship between a number of cognitive beliefs and appraisal processes and obsessive-compulsive symptoms. This thesis presents the results of three studies. The first study was designed to investigate the hypothesis that certain beliefs are more prevalent in OCD, compared with other anxiety disorders. The second study expands on earlier findings by examining whether the six metacognitive beliefs proposed by the Obsessive Compulsive Cognitions Working Group, (OCCWG; 1997, 2001, & 2003) correlate with specific symptom-based OCD subtypes. The final study addresses some of the methodological weaknesses inherent in retrospective self-report measures by replicating the study using experimental techniques. Most importantly, this research was conducted from within the theoretical framework of Rachman (1993) and Salkovskis (1989) models which emphasise the misinterpretation of significance of the intrusive thoughts. The first study explored the relationship between thought-action fusion (TAF) and inflated responsibility beliefs across individuals diagnosed with obsessive compulsive disorder (OCD), an anxiety disorder other than OCD (anxious controls; AC), and a non-anxious control group (NAC). It was hypothesized that the OCD group would evidence significantly higher inflated responsibility and TAF scores, compared to the AC and NAC groups. In this study, non-clinical and clinical participants were recruited for research. The non-clinical group was comprised of undergraduate students (n = 22: mean age = 26.8; SD = 9.2). The clinical groups included 20 participants with OCD as their primary diagnosis (mean age = 32.1; SD = 11.9) and 21 individuals diagnosed with another anxiety disorder (mean age = 32.2; SD = 10.9). To measure inflated responsibility beliefs and thought action fusion, self-report questionnaires were administered to the participants. The results of this study demonstrated that inflated responsibility beliefs, while present in other anxiety disorders, were significantly higher in participants with OCD, even after controlling for depressed mood and TAF levels. No group differences emerged between the OCD and anxious groups on measures of TAF. Thus, it can be tentatively concluded that inflated responsibility beliefs may have a more robust relationship with OCD than TAF beliefs, which appear to act as a general vulnerability factor occurring along a continuum of anxiety disorders. The second study examined the associations between the six OCD-related beliefs: control of thoughts, importance of thoughts, responsibility, intolerance of uncertainty, overestimation of threat and perfectionism and five empirically derived OCD subgroups. Clinical participants with a primary diagnosis with OCD (n = 67: mean age = 38.0; SD = 11.7) were recruited over a period of two years from the Anxiety Disorders Unit. Participant responses were cluster analysed to form five stable groups: aggressive obsessions-checking compulsions (n = 22: mean age = 26.8; SD = 9.2); contamination obsessions-cleaning compulsions (n = 22: mean age = 26.8; SD = 9.2); symmetry concerns-ordering/arranging compulsions (n = 22: mean age = 26.8; SD = 9.2); hoarding obsessions-hoarding compulsions (n = 22: mean age = 26.8; SD = 9.2); and miscellaneous obsessions -miscellaneous compulsions (n = 22: mean age = 26.8; SD = 9.2). The second found that intolerance of uncertainty was significantly related to the contamination subgroup. While responsibility and threat estimation beliefs were higher in the aggressive-checking subgroup, these differences did not reach statistical significance. No other significant results were found, however, there was a non-significant trend for perfectionism beliefs to be higher in symmetry-ordering and hoarding subgroup. Following the results of this study, questions remained about whether the lack of significant findings reflected the generality of these beliefs or were due to methodological differences. This led to the development of the final study presented in this thesis. The purpose of the final study was to investigate whether the second study was limited by the method of assessment (e.g. self-report questionnaires). This study was unique, as it was the first of its kind to experimentally manipulate all six beliefs in empirically derived OCD subtypes. Twenty participants (mean age = 45.0; SD = 11.0) were chosen from the second study to form the following priori groups: contamination (n = 4: mean age = 44.5; SD = 9.5); aggressive (n = 6: mean age = 46.5; SD = 7.2); hoarding (n = 4: mean age = 47.2; SD = 6.9); and symmetry (n = 6: mean age = 41.8; SD = 17.4). Six behavioural experiments designed to reflect one of the six OCCWG beliefs were specifically developed and administered to the groups. Baseline scores were obtained using self-report questionnaires. The study found strong support for the use of experimental paradigms over self-report measures, as several significant interactions between cognitive beliefs and OCD symptom-based subtypes were found. Specifically, the hoarding subgroup evidenced significantly higher overall thought action fusion scores compared to those in the contamination group. The symmetry subgroup exhibited significantly higher anxiety than the aggressive group during the perfectionism task and demonstrated significantly higher scores on several items measuring perfectionism compared to the contamination group. Finally, over-estimation of threat beliefs was significantly higher in the contamination thoughts. No statistically significant group differences were found for controllability of thoughts, responsibility and intolerance of uncertainty. In conclusion, these studies collectively showed that in some cases of OCD certain beliefs appear highly applicable, whereas in others they are not. This finding may explain why some OCD patients have poor treatment outcomes as the beliefs and appraisals were highly variable across groups. These findings are of both theoretical and clinical significance because they add to the growing understanding that OCD may consist of distinct clusters of symptoms with different underlying motivations and beliefs. This finding is of clinical significance because treatment guidelines for OCD can become more specific, factoring into the therapy situation these underlying beliefs and appraisal processes. Lastly, the findings regarding inflated responsibility deserve special mention, given the significance of this construct in contemporary cognitive models. The results of the present studies were mixed with regard to responsibility as only the first study found a significant result. It appears that, like the other belief domains proposed by the OCCWG, responsibility may not be specific to all types of OCD and current cognitive models may benefit was shifting the emphasis to other belief domains.

Anxiety disorders are often associated with fear related to living in a society whose members may attach negative and degrading terms to mental health conditions. Although anxiety disorders are more prevalent among African Americans, treatment-seeking behavior rates are lower in the African American community. Cultural and social perceptions of mental health care's effectiveness and accessibility can act as barriers to treatment seeking by African American men diagnosed with anxiety disorders. A multiple case study approach was used in this qualitative study to investigate how African American men cope with the disorders and whether they hold integrated, gender-distinct beliefs about the cultural and social effects that may contribute to delays in treatment-seeking behaviors. The health belief model was used in conjunction with the theory of planned behavior as the conceptual framework for understanding the data. Purposive sampling of African American men diagnosed with anxiety disorders was used to recruit 5 study participants. In-depth interviews were conducted and recorded on a digital recorder. Results and findings from content analysis support the premise that medication nonadherence, along with the themes developed in this studyâ??â??social isolation, inner nervousness, thoughts and feeling about medication, past trauma and violence, alternative ways of coping, and lack of trust in the treatment systemâ??â??make a plausible argument for why African American men do not seek treatment for anxiety disorders. This study contributes to social change by informing community workers and agencies about reasons for African American men not seeking treatment, and the need for increased awareness, community outreach programs, and more universal cognitive testing of anxiety disorders for this population.

Magister Psychologiae - MPsych / The propensity to blush is typical of many individuals with social anxiety disorder (SAD). SAD is also associated with significant disability or functional impairment. The relationship between SAD, blushing and functional impairment is still not completely understood however. This study has focused on the association between the propensity to blush and reported level of functional impairment due to SAD. Data from thirty-eight (n=38) individuals with SAD, were collected via a larger study conducted at the MRC Anxiety and Stress Disorders Unit. Assessment tools include the Structured Clinical Interview for Axis I disorders – Patient Version (SCID -I/P), Social Phobia Inventory (SPIN) and the Blushing Propensity Scale. Demographic and clinical data were gathered and reported on. Spearman rank order correlations were used to determine relationships between variables, including blushing propensity, disability and symptom severity. Results were reported on and then discussed using the social attention theory. Limitations and recommendations were proposed in the final and concluding chapter. This study, as part of a larger study at the MRC Research Unit on Anxiety and Stress Disorders, has been approved by the Research Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch

Social anxiety disorder (SAD) is characterized by fear and avoidance of social interactions and situations in which an individual is being the focus of attention. This current thesis aims to examine the efficacy of pharmacological treatment, particularly selective serotonin reuptake inhibitors (SSRIs) in individuals with a generalized social anxiety disorder (gSAD) in comparison with placebo (no active medication). In this systematic review, Scopus and Web of Science were searched for relevant research regarding the efficacy of the SSRI medication (paroxetine, sertraline, fluvoxamine and escitalopram) in comparison with placebo. Sixteen articles were included in this analysis. Results demonstrated that SSRI medication has greater efficacy in comparison with placebo both in short- and long-term time, prevent relapse in the long-term treatment of SAD and had a beneficial effect on different areas of individuals life's such as work, performance, romantic relationships etc.

Social anxiety disorder (SAD) interferes with everyday life. It can, for instance, hinder careers, relationships, and leisure time. It is a common anxiety disorder that was neglected for decades. SAD individuals crave and fear social interactions simultaneously, leading to isolation in our highly social world. Therefore, research surrounding these kinds of disorders is essential. This systematic review has focused on the neural aspects and differences between SAD and healthy controls surrounding amygdala activation and connectivity. Functional magnetic resonance imaging (fMRI) studies conducted using social and emotional tasks were included. Findings include increased amygdala activation to fearful faces and words and a positive correlation between amygdala activation and symptom severity. Further, deficits in emotion regulation and a finding of gradual habituation have been found in SAD compared to healthy controls. Some limitations to this research are the small sample sizes used in the included articles and the use of both SAD and individuals with generalized SAD. The study is essential to assess future questions and directions regarding diagnosis, treatment, and understanding of SAD.

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The relationship between alcoholism and generalized anxiety disorder (GAD) has been discussed in two research areas: research on the prevalence of GAD in alcoholics, and the prevalence of alcoholism in individuals diagnosed with GAD. Studies indicate that between 6 to 26% of alcoholics have a current diagnosis of GAD, with a lifetime prevalence rate of up 51%. In the general population, 4% would currently receive a diagnosis of GAD, with a lifetime prevalence of 8%. This meta-analytic review of the empirical literature examines the relationship between GAD and alcoholism. The author used percentages to compare the results of various studies. The averaged results of these various studies suggested there is a 25% comorbidity rate of GAD and alcoholism. critical review of the studies examined in this review revealed substantial methodological errors. Based on a critical review of the research methodology in the studies cited, the author proposed further research.

A large body of research indicates that worry, anxiety, and depression are present in the modern American psyche at increasingly high levels. Everyday worry can lead to further mental health issues, interpersonal problems, and reduced physical wellbeing and should be reduced when possible. Previous research has examined the benefits of church attendance with varied results; however, understanding the relationship between church attendance and everyday worry could be useful in reducing the effects of worry on this population. The purpose of this quantitative study was to measure self-reported levels and causes of everyday worry among church-goers from three congregations and to examine the relationship among peers when sorted by frequency of church attendance and demographic group. Participants completed demographic questions and the Penn State Worry Questionnaire online. The survey was distributed among 3 congregations in the Raleigh, North Carolina area. The 3 congregations represented a spectrum of churches from the Baptist tradition in an attempt to determine if there were significant differences among conservative, moderate, and liberal churches. Two hundred sixty-six usable surveys were returned, an 84% response rate. Results from the statistical analysis indicated that more frequent church attendance was associated with less worry. Women tended to worry more than men, and younger people tended to worry more than older people. There was no significant relationship between level of worry and church type (conservative, moderate, or liberal).