Generalized Anxiety Disorder (GAD) is one of the most common and impairing childhood anxiety disorders, impacting over 10% of children with an average age of onset at 8.5 years. GAD in childhood increases the risk for developing additional anxiety and depressive disorders, academic and social difficulties, and, if left untreated, continuity into adulthood. While treatments incorporating mindfulness techniques have been shown to be efficacious among adults, relatively few studies have examined the efficacy of these techniques in the treatment of children. Mindfulness skills may be able to target maladaptive cognitive patterns by teaching children more flexible ways of thinking and viewing the world and providing children additional coping skills that may positively impact their overall functioning long-term. The aim of the present study was to develop and provide preliminary evaluation of a mindfulness-based intervention for GAD in school-aged children. Four children aged 9 to 12 with a principal diagnosis of GAD completed an open trial pilot phase of a 6-session individual format mindfulness intervention. Each session emphasized mindful awareness of breath, body, and thoughts, and involved child and parent participation. An additional twelve children were randomized to either an immediate treatment (n = 6) or a waitlist (i.e., delayed treatment; n = 6) condition during the course of a randomized waitlist-controlled clinical trial. Measures were administered at pre-waitlist (if applicable), post-waitlist/pre-treatment, post-treatment, and eight weeks following treatment to assess overall program satisfaction and changes in symptoms and diagnosis. Overall, treatment dropout was low, and families reported high satisfaction with treatment. Relative to waitlist, children in the immediate treatment group evidenced significant difference in mean change scores on Clinical Global Improvement Severity score and Child Behavioral Checklist Internalizing and Anxiety Problems scales. Effect size statistics indicated very large effect sizes between the waitlist and immediate treatment groups for change in GAD Clinical Severity Rating, child self-report of worries, and mindfulness ability, despite non-statistical significance. Overall, the intervention demonstrated feasibility, acceptability, and preliminary evidence of potential efficacy even in this small pilot study. Effect size estimates suggest a larger randomized clinical trial is warranted to fully evaluate treatment efficacy.

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Twelve trait anxious male, federal prisoners with high self-esteem and twelve trait anxious male, federal prisoners with low self-esteem participated in the study. Subjects were selected from among those volunteering to participate and who met the scoring criteria on the IPAT Anxiety Scale Questionnaire and on the Self-Esteem Scale from the Minnesota Multiphasic Personality Inventory II. Each volunteer participated in one session of approximately 50 minutes in length. Each subject was asked to respond to a medical/psychological interview, after which he was asked to listen to and follow a series of instructions (autogenic training). Throughout the session electromyographic and skin temperature measurements were taken from each subject's dominant forearm and non-dominant middle finger, respectively. At the end of the session each volunteer was asked to complete the STAI-State Scale. The purpose of the study was to evaluate the role of self-esteem as a moderator of trait anxiety. In addition, the study was designed to assess the effectiveness of autogenic training with this population. Results indicate no significant difference between high and low self-esteem subjects on measurements of electromyography/ F (1, 22) = .63, p > .05 or peripheral skin temperature F (1, 22) = .20 p > .05. However, a significant difference was found between high and low self-esteem subjects on the STAI-State Scale, F (22) = 4.45 p < .05. High self-esteem subjects obtained significantly lower raw scores than low self-esteem subjects on the state anxiety measurement. A significant difference was also found for the block of trial factor (baseline/relaxation periods) for the electromyography F (6, 132) = 3.43, p < .01, and peripheral skin temperature F (6, 132) = 6.32, p < .001 measurements. Results present partial support for the role of self-esteem as a moderating variable in trait anxious subjects. Self-esteem is conceptualized as a form of self-efficacy.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Introduction: There are few studies that examine the factors associated with the different levels of health anxiety in medical students. The objective was to determine the factors associated with the levels of health anxiety in medical students in 2018. Methods: An analytical cross-sectional study was carried out with 657 medical students from a private Peruvian university. Participants answered a questionnaire from which information was collected regarding levels of health anxiety (SHAI). For the analysis, linear regression was used to calculate crude and adjusted betas, and their 95% confidence intervals. Results: The mean health anxiety score was 14 ± 6.7. An association between health anxiety and the year of study is reported, with the second year showing the highest scores. In addition, an association between health anxiety and smoking is highlighted, as there are higher levels in occasional smokers, as well as a weak inverse correlation with age. No association was found with sex, place of birth, or having a first-degree relative that is a doctor or health worker. Conclusions: The present study showed that age, year of studies and smoking are associated with health anxiety levels. More studies are required, especially of a longitudinal nature. / Revisión por pares

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Dental anxiety is a major public health problem that leads to underutilization of dental care and poor oral health. Much research has demonstrated an association between the expectation of pain during dental treatment and dental anxiety; however, not all patients with high pain expectancy develop dental anxiety, suggesting that other factors may impact the degree to which pain expectancy increases dental anxiety. The present study examined whether anxiety sensitivity (AS; the fear of negative consequences of anxiety-related symptoms and sensations) increases the strength of the relationship between pain expectancy and dental anxiety. Participants were 104 adult patients of Temple University Kornberg School of Dentistry clinics. Baseline levels of AS and pain expectancy were assessed using self-report questionnaires. Baseline dental anxiety was assessed using self-report questionnaires and measures of psychological/physiological stress reactivity to films of dental procedures. Participants also underwent a pain expectancy induction, and all indices of dental anxiety were re-assessed following the pain expectancy induction. Linear regression analyses revealed that, in contrast to expectations, AS did not strengthen the relationship between self-reported or laboratory-induced pain expectancy and any indicators of dental anxiety. On the contrary, there was limited evidence that AS may weaken the pain expectancy-dental anxiety relationship. Consistent with previous studies, there was a strong pattern of findings supporting a direct association between pain expectancy and dental anxiety, but limited evidence of a direct association between AS and dental anxiety. AS may not be a strong risk candidate for dental anxiety, and future studies examining other theoretically-relevant vulnerability factors are needed to elucidate pathways through which pain expectancy leads to greater dental anxiety. / Psychology

The present study investigated the efficacy of heart rate feedback training in the treatment of panic disorder. Eight patients with anxiety disorders participated in 7 feedback sessions, in which they were instrumentally trained to produce increases and decreases in heart rate in the presence of visual feedback. When they could successfully differentiate between the increase and decrease responses, subjects were instructed to use the decrease response to control anxiety and panic, and to avoid the increase response. Subjects were not made aware of the target responses until training was completed. Clinical improvement was measured through the administration of a psychometric test battery and a daily anxiety/panic diary. A non-anxious Control group, consisting of 10 subjects, was utilized to provide comparisons with the Anxiety group in the areas of feedback skill, baseline psychophysiology, and change in anxiety levels with the development of feedback skill. As a result of feedback training, Anxiety patients learned to produce increases and decreases in heart rate in the presence and absence of feedback. They also reported a decline in anxiety and panic over the course of feedback training. To evaluate whether clinical improvement was related specifically to feedback skill as opposed to non-specific treatment factors, dose-response relations were examined, where a dose was defined as a subject's degree of differentiation between increases and decreases in heart rate, as measured by a t-test. Clinical improvement was measured as the change in number of panic attacks per day, compared to baseline. A positive, significant correlation was found between subjects' degree of feedback skill and decline in panic at a one-month follow-up. A number of alternative explanations for the dose-response relationship are discussed, as well as the limitations of this study. It is concluded that further well-controlled studies will be required to confirm these findings, and to determine the source of the dose-response relationship, although this study provides encouraging evidence for the use of feedback training as a behavioral treatment for panic disorder. / Thesis / Master of Science (MS)

published_or_final_version / Psychology / Doctoral / Doctor of Philosophy

published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

This document proposes a study to ascertain if a relationship exists between levels of child and parent anxiety symptoms during an intervention designed to decrease anxiety in youth. This document systemically describes family variables related to anxiety in youth at the individual, parent-child, marital, whole family, and extra familial subsystem levels, in addition to previous research analyzing parental anxiety and the direction of change between child and parent anxiety during youth-focused interventions. The study involves gathering anxiety symptom data from parent and child participants at 14 time points and analyzing it using dependent samples t-test, regression, and ANOVA repeated measure analyses. These analyses serve to answer the research questions of whether child and parent anxiety symptoms improve in a youth-focused CBT intervention for anxiety from pre- to post-treatment, whether there exists a significant relationship between the severity of anxiety symptoms in youth and parents surrounding a youth-focused anxiety intervention, and whether this relationship is consistent. / text