Diss. (sammanfattning) Uppsala : Univ., 2003. / Härtill 5 uppsatser.

No description available.

The purpose of this study was to investigate the process of change during three interventions for claustrophobia, and to provide descriptive data about this fear. Forty-eight participants, recruited from the community through the local media, were randomly assigned to one of four groups: exposure to the locked test closet used for assessment, exposure to the sensations of anxiety (interoceptive exposure), modification of underlying negative cognitions, or a control group. All interventions were given over three sessions. The exposure group proved superior to the control on a wide range of measures. In the cognitive group, scores of reported fear and panic, but not predictions of fear or heart rate, were lowered, an important finding since this group had no exposure to the closet during training. The interoceptive group made some modest gains, but these did not translate into reduction in fear scores. An analysis of the timing of fear reduction, and of treatment generalization, provided some clues as to the mechanism of change. Structured interviews provided data on aspects of the fear including its onset, patterns of current avoidance, and common salient cognitions. The results are discussed in the light of recent findings on panic disorder. / Arts, Faculty of / Psychology, Department of / Graduate

Clinical characteristics, methods of treatment and outcome in School Refusal have been investigated. School refusal/phobia has been reported in the literature not to be a true clinical entity with a uniform aetiology, psychopathology, course, prognosis and treatment, but rather a collection of symptoms or a syndrome occurring against the background of a variety of psychiatric disorders. Aetiological and precipitating factors also vary with age, psychosocial level of development and personality factors in the individual child, family structure and function, and the school setting. Data were collected retrospectively from 20 cases treated at the Child and Family Unit, Red Cross War Memorial Children's Hospital, Cape Town during a specific time period. Analysis of the data revealed a gender distribution of 11 boys and 9 girls; 1 girl, 5 - 8 years old and 11 boys and 8 girls 9 - 13 years old. One Asian, no Black, 13 Coloured and 6 White children were represented. A large section of the sample population represented the lower socio-economic group as determined by parental qualification and occupation. Most of the families tended to consist of more than 2 children (5 member families). Family dysfunction was recorded in all but one case, with evidence of a recognizable psychiatric disorder also recorded quite frequently in the nuclear family members. Educational difficulties were recorded in a third of the sample together with below average total IQ scores in virtually all the subjects evaluated. The bulk of referrals were from medical practitioners and relatively few from schools. Refusal to attend school was of relatively short duration in three-quarters of the sample. Most of the cases were first time school refusers. Accompanying symptoms or problems were mainly anxiety or depression - related whereas significant associated events were mainly family - oriented. Psychiatric disorders diagnosed most often were anxiety and affective disorders with overlap of the 2 conditions recorded in half the sample. Response to treatment was positive in two thirds of the sample and a combination of treatment methods proved to be the most successful treatment plan. School refusal as investigated in this study, was well represented in a population of children treated at a Child Psychiatric Out-Patient Unit. A high rate of resemblance on various aspects of school refusal was recorded between the study sample and reports in the literature reviewed.

This study is concerned with children's anxiety regarding school attendance of which school phobia is the most extreme form. A literature cull identified features believed to typify the school phobics pattern of anxiety and these were included in a battery of instruments administered to a random sample of 225 boys and 261 girls between the ages of 11 and 16 years. This battery was also administered to a sample of 30 clinically defined school phobic boys and 19 school phobic girls. Four groups, validated by a series of Discriminant Function Analyses, emerged in this study. These groups are taken to represent a continuum of anxiety relating to school attendance from severe to anxiety free. Evidence is adduced for the need to evaluate boys and girls data separately. The groups were found to differ for both boys and girls in terms of age and ability but not social class or the number of other fears experienced though slight differences in the nature of fears emerged. Overall the girls groups more commonly reported fears. Difficulties with friendships emerged as highly significant. However there were sex differences in the importance of the age and sex of friends variables and in whether the friends come from the childs own school. Differences also emerged on a specially created Vulnerability in School measure but not on a General Satisfaction with School scale. Sociometric data reliably discriminates among the groups for both boys and girls though generally did not appear to have an impact on favoured spare time activity. The school avoidance strategy of pretending to be sick did not prove to be significant though recourse to truancy did - especially among the boys. Additionally, significantly more sleep and nighttime problems are revealed among the more anxious groups for both boys and girls. The significance of these and associated other findings are analysed and a tentative model of the anxious childs' situation in terms of theories of Stress and Gaping nominated as furnishing a possible synthesis.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

The present research was undertaken to investigate the effects of two independent variables considered potentially important to the reduction of fear through systematic desensitization. The first independent variable investigated was the importance of making covert motor responses when instructions were given to imagine motor behavior. Electromyographic measures were obtained on subjects' covert muscular activity as they imagined themselves raising their arms. The subjects were then classified, on the basis of their average electromyographic responsiveness, as high-responders (those showing relatively high levels when imaging movement) and low-responders. A 2 X 2 analysis of covariance showed a significant difference in the posttreatment scores of the high- and low responders on performance measures, the high-responders performing better. The difference between the two instruction groups was not statistically significant. Additional analyses indicate the importance of the instruction variable is mitigated by the extent to which subjects actually follow the particular instructions given. These data imply electromyography may be used in clinical practice as an assessment tool to determine which subjects are likely to respond to systematic desensitization. They also suggest the possibility of using response measures to train self-monitoring of imagery. Concerning the imagery construct, the present study offers an empirical alternative to the traditional conceptualization. The data obtained support the utility of the analysis of imagery advanced in this paper.

A ressonância magnética (RM) é um exame de diagnóstico por imagem amplamente utilizado e permite a obtenção de imagens de diversos segmentos do corpo com alta qualidade. Embora seja um exame de excelência, os pacientes que se submetem a esta técnica, podem apresentar claustrofobia em razão do espaço limitado dentro do equipamento. A claustrofobia é considerada um estado de ansiedade e classificada como uma fobia específica pelo DSM IV. O Questionário de Claustrofobia (CLQ) é um instrumento de mensuração, que foi criado em língua inglesa e posteriormente, foi traduzido e validado para outras línguas e culturas, inclusive no Brasil em 2008. Trata-se de uma escala do tipo Likert, com escores que variam de 0 (nada ansioso) a 4 (extremamente ansioso); possui 26 itens que são distribuídos em dois domínios (sufocação 14 itens e restrição 12 itens). OBJETIVO: Avaliar as propriedades psicométricas da versão brasileira do Questionário de Claustrofobia, aplicado a pacientes submetidos à Ressonância Magnética. MATERIAL E MÈTODO: Foram realizadas a avaliação da consistência interna, análise fatorial confirmatória, validação de construto convergente (correlacionado Questionário de Claustrofobia com o Inventário de Ansiedade - Estado), validação de construto discriminante e aplicação da curva ROC para propor um ponto de corte para o instrumento. A coleta de dados foi feita em um hospital de grande porte do Município de São Paulo com 300 pacientes que realizaram ressonância magnética; pela aplicação de três instrumentos, sendo eles: o de caracterização biossociodemográfica, Questionário de Claustrofobia e Inventário de Ansiedade - Estado. RESULTADOS: A confiabilidade interna medida pelo coeficiente alfa de Cronbach obteve os seguintes valores: para o total da escala 0,94; para os domínios sufocação, 0,80 e restrição, 0,93. A análise fatorial confirmatória confirmou dois domínios e obteve valor de NNFI 0,692, considerado bom valor de ajuste para o modelo. A validação de construto convergente correlacionou o CLQ com o Inventário de Ansiedade- Estado e os valores obtidos foram muito próximos a zero, indicando que não há relação entre os instrumentos (r - 0,111). Já a validação de construto discriminante, em que foi utilizado o teste Mann-Whitney, foi capaz de discriminar os grupos claustrofóbicos com as variáveis claustrofobia referida, RM prévia e faixa etária. Foi estabelecido o ponto de corte pela curva ROC e a pontuação se for, igual ou maior que 16 pontos, sugere o potencial desenvolvimento da claustrofobia. CONCLUSÃO: Os resultados permitiram concluir que o Questionário de Claustrofobia teve desempenho satisfatório, atestando sua confiabilidade e mostrando-se válido para medir a claustrofobia no ambiente de ressonância magnética. / Magnetic resonance imaging (MRI) is a diagnostic imaging widely used and allows obtaining images of various body segments with high quality. Although an examination of excellence, patients who undergo this technique may have claustrophobia due to the limited space inside the equipment. Claustrophobia is considered a state of anxiety and classified as a specific phobia by DSM - IV. The Claustrophobia Questionnaire (CLQ) is a measurement tool, which was created in English and then translated and validated for other languages and cultures, including Brazil in 2008. It is a Likert scale, with scores ranging from 0 (not anxious) to 4 (extremely anxious); has 26 items that are divided into two domains (14 items suffocation and restriction 12 items). OBJECTIVE: To evaluate the psychometric properties of the Brazilian version of the Claustrophobia Questionnaire applied to patients undergoing MRI. MATERIAL AND METHODS: We performed an evaluation of internal consistency, confirmatory factor analysis, convergent construct validation (Claustrophobia Questionnaire correlated with Anxiety Inventory - State), discriminant construct validation and application of the ROC curve to propose a cutoff point for the instrument. Data collection was done in a large hospital in São Paulo with 300 patients who underwent MRI, the application of three instruments, namely: the characterization of bio socio demographic protocol, Claustrophobia Questionnaire and Anxiety Inventory - State. RESULTS: The internal reliability as measured by Cronbach\'s alpha obtained the following values: for the total scale 0.94; domains to suffocation, restriction and 0.80, 0.93. Factor analysis confirmed two domains and obtained value of NNFI 0.692, considered good value adjustment to the model. Validation convergent construct the CLQ correlated with State Anxiety Inventory and the values obtained were very close to zero, indicating no relationship between the instruments (r - 0.111). Already construct validation discriminant, in which we used the Mann-Whitney test was able to discriminate between claustrophobia claustrophobic with the variables mentioned, previous CABG and age. Was established cutoff by ROC score and if equal to or greater than 16 points, suggests the potential development of claustrophobia. CONCLUSION: The results showed that the Claustrophobia Questionnaire showed a satisfactory performance, proving its reliability and proving to be valid to measure the claustrophobia in MRI environment.

We evaluate the long-term test–retest reliability and procedural validity of phobia diagnoses in the UM-CIDI, the version of the Composite International Diagnostic Interview, used in the US National Co-morbidity Survey (NCS) and a number of other ongoing large-scale epidemiological surveys. Test–retest reliabilities of lifetime diagnoses of simple phobia, social phobia, and agoraphobia over a period between 16 and 34 months were K = 0·46, 0·47, and 0·63, respectively. Concordances with the Structured Clinical Interview for DSM-III-R (SCID) were K = 0·45, 0·62, and 0·63, respectively. Diagnostic discrepancies with the SCID were due to the UM-CIDI under-diagnosing. Post hoc analysis demonstrated that modification of UM-CIDI coding rules could dramatically improve cross-sectional procedural validity for both simple phobia (K = 0·57) and social phobia (K = 0·95). Based on these results, it seems likely that future modification of CIDI questions and coding rules could lead to substantial improvements in diagnostic validity.