Cognitive-Somatic Anxiety Questionnaire Research Articles

A take-home placebo treatment can reduce stress, anxiety and symptoms of depression in a non-patient population.

With a healthcare system burdened by symptomatic and mental-health related conditions, the placebo effect may represent a useful clinical tool. First, however, there is a need to broaden research attention and investigate placebo effects outside laboratories and beyond experimental pain. This study investigated the effectiveness of a take-home placebo treatment in the short-term alleviation of stress, anxiety and symptoms of depression in a non-patient population. A sample of 77 participants was randomized to either the 'oxytocin' treatment group (n = 22), the 'serotonin' treatment group (n = 22) or the wait-list control group (n = 33). The two treatment groups were given an 'anti-stress treatment spray' (placebo) to self-administer for 3 days, and completed online measures of perceived stress (Perceived Stress Scale-10), anxiety (Cognitive Somatic Anxiety Questionnaire) and symptoms of depression (Centre for Epidemiological Studies - Depression) before and after the 3-day protocol. Both the 'serotonin' and 'oxytocin' treatment sprays were effective in reducing symptoms of depression; however, only those in the 'oxytocin' group reported less stress and anxiety as compared with controls. Overall, the 'oxytocin' was perceived as more effective. Placebo effects can be translated to a real-life setting in the short-term reduction of stress, anxiety and symptoms of depression in a non-patient population. In treating psychological distress, placebos may be useful addition to the treatment repertoire. The information given with treatment may also be an important consideration for practitioners.

Abstract B12: Improving quality of life among Latina breast cancer survivors using the “Staying Healthy” program

Abstract For Latina women, breast cancer is the leading cancer and we expect this trend to continue as the US Hispanic population expands. Latinas generally have lower survival rates for most cancers, even after accounting for differences in age and stage distribution, which may reflect less access to timely, high-quality treatment. Despite these challenges observed among Latina breast cancer survivors (BCS), there is very limited knowledge of survivorship-related issues and priorities among Latinas, specifically the effectiveness of using patient navigators (PN) to link Latina BCS with unmet psychosocial needs to appropriate psychosocial services, screening, risk reduction services and treatment follow-up. Methods: The Institute for Health Promotion Research at the University of Texas Health Science Center at San Antonio is conducting “Staying Healthy,” a two-year, two-arm randomized controlled trial (75 planned in each arm) of patient navigation among Latina BCS (Susan G. Komen for the Cure Grant #SAB-08-00005). The study compares Enhanced PN (PN+) to Usual PN over time. PN+ subjects receive tailored educational materials and regular personalized assistance including phone calls, meetings, and coordination of targeted care. Usual PN comparison subjects receive navigation upon request for specific needs. All navigation is conducted by trained paraprofessionals from the target community. Participants are Latina BCS age 18 and older who have completed primary treatment at least 3 months prior to study entry, have no metastatic disease, lack cancer or co-morbidity screening and have no ongoing neo-adjuvant therapy. Study outcomes include general and breast cancer-specific quality of life (QOL: Functional Assessment of Cancer Therapy-General, FACT-G, and breast cancer-specific, FACT-B), and compliance with health care recommendations and screening practices. The study includes overall descriptive statistics and hierarchical linear regression of QOL scores at baseline on self-efficacy (SE), communication (Perceived Efficacy in Patient-Physician Interactions, PEPPI), needs (Supportive Care Needs Survey, SCNS), levels of distress (adapted Cognitive Somatic Anxiety Questionnaire, CSAQ), and worry interference (WI), controlling by acculturation (Short Acculturation Scale for Hispanics, SASH), age, and time (months) since primary treatment. Results: We have conducted the baseline analyses of 120 enrolled Latina BCS who average 3.6 years post-diagnosis (SD=2.8 years) and 3.2 years post-primary treatment (SD=2.6 years). About 57% of participants reported having Medicare or Medicaid healthcare coverage. Participants were an average age of 57.3 (SD=9.5 years), 38% Spanish monolingual, 58% US born, 47% married or in an equivalent relationship, and 87% parents. More than three-fifths of the sample (61%) reported an annual household income below $25,000. Consistent with prior work with Latina BCS, our sample reported similar general health-related (M=82, SD=16.8) and breast cancer-specific (M=107, SD=21.4) QOL as measured by the FACT-G and FACT-B scales, respectively. Lower levels of distress (adapted CSAQ) were significantly associated with higher scores of both general QOL (β = -1.3, 95% CI -1.7, -0.9, for FACT-G) and disease-specific QOL (β = -1.9, 95% CI -2.3, -1.4, for FACT-B) after controlling by age, time since primary treatment, and acculturation score. Conclusion: These results show that among Latina BCS, levels of distress and QOL (general and breast cancer-specific) are inversely associated regardless of age, time since primary treatment, and degree of acculturation. Interventions to address unmet psychological needs may be one effective approach for ameliorating distress and enhancing QOL in this vulnerable population. Citation Format: Edgar Munoz, Alfredo A. Santillan-Gomez, Amanda Sintes-Yallen, Kipling Gallion, Amelie G. Ramirez. Improving quality of life among Latina breast cancer survivors using the “Staying Healthy” program. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B12.

The psychometric properties of the Cognitive-Somatic Anxiety Questionnaire in Chinese undergraduate students and clinical patients

BackgroundThe present study was conducted to develop a Chinese version of the 14-item Cognitive-Somatic Anxiety Questionnaire (CSAQ) and examine its psychometric properties. MethodsThe original English version of the CSAQ was first translated into Chinese and then backtranslated and modified until cross-language equivalence was established. This version was then completed by 2168 undergraduate students and 289 clinical patients with mental disorder in China. The Mood and Anxiety Symptoms Questionnaire (MASQ) was also administered to students. Confirmatory factor analysis was performed to examine the two-factor construct, and the CSAQ's internal consistency, test–retest reliability, and concurrent and discriminant validity were also evaluated. ResultsThe two-factor model (cognitive and somatic) of the CSAQ was confirmed, and the scale showed an adequate model fit in the student and clinical samples. The CSAQ showed adequate internal consistency (student sample: Cronbach's α=0.82, mean inter-item correlation coefficient=0.25; clinical sample: Cronbach's α=0.81, mean inter-item correlation coefficient=0.23) and good stability (2-week test–retest reliability in student sample, 0.84). The coefficient of correlation between CSAQ and overall anxious symptoms MASQ scores among students was 0.64. ConclusionsThe Chinese version of the CSAQ is a promising instrument for reliable and valid measurement of anxiety in Chinese populations.

Measurement of anxious traits: a contemporary review and synthesis

Trait anxiety is a characteristic predisposition to appraise stimuli as threatening and respond with anxiety. Trait anxiety is proposed to serve as a vulnerability factor for greater frequency and intensity of anxiety experiences as well as the development of anxious pathology. Cognitive, behavioral, and physiological components of trait anxiety have been described. Common self-report measures of trait anxiety are reviewed with an emphasis on: components assessed, factor structure, internal consistency, reliability, and construct validity. Measures were selected if instructions ask individuals to endorse items based on their characteristic, rather than a time sensitive, response. Selection criteria resulted in a focus on the following measures: the State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory-Trait (BAIT), Cognitive Somatic Anxiety Questionnaire (CSAQ), Endler Multidimensional Anxiety Scales-Trait (EMAS-T), Four Systems Anxiety Questionnaire (FSAQ), State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA), and the Three Systems Anxiety Questionnaire (TSAQ). While the STAI has the advantage of normative data and frequent use in prior research, newer measures, such as the BAIT and the STICSA, demonstrate greater discriminant validity. The strengths and weaknesses of each of the reviewed measures are highlighted. Recommendations for measure selection and future research are provided.

Validation of the Spanish version of the Anxiety Sensitivity Index in a clinical sample

In this study we validated the Spanish version of the Anxiety Sensitivity Index (ASI) in a sample of anxiety disordered patients. The results revealed that: (1) ASI scores were higher for anxiety disordered patients than for normal control subjects, and higher for patients with panic disorder (PD) than for patients with other anxiety disorders (OAD). In contrast, there were no differences among the groups on the Cognitive-Somatic Anxiety Questionnaire (CSAQ). (2) Using discriminant analysis, we were able to differentiate PD patients from patients with OAD on the ASI, but not on the CSAQ. (3) Results supported a unidimensional factor-structure for the ASI. (4) Data provide cross-cultural evidence for construct validity and concurrent validity of the Spanish ASI, and provide further evidence for the usefulness of the concept of anxiety sensitivity.

The effect of social change on causal beliefs of mental disorders and treatment preferences in Ghana

The present study investigated the associations between social change, personality, causal beliefs and treatment style and goal preferences of 375 Ghanaian teachers. The index of social change (ISC) was conceptualized as the average percentile rank of a person's income, education and acculturation. The self-report measures (greatly modified after two pilot studies) were subscales of the SuinnLew Acculturation Scale, the Depressive Experiences Questionnaire (dependency), the Sociotropy-Autonomy Scale (autonomy), the Symptom Checklist '90 (paranoid ideation), the Spheres of Control Scale, and the Cognitive Somatic Anxiety Questionnaire. Respondents also completed a questionnaire on causal beliefs and treatment preferences pertaining to mental disorders. Results indicated that beliefs and treatment preferences were affected by the index of social change (ISC) and were specific to type of disorder. High ISC teachers endorsed significantly higher ratings on belief in an internal cause for Depression and Dependent Personality Disorder, and indicated greater preference for participation in treatment than lower ISC teachers. Contrary to prediction, lower ISC teachers indicated a greater preference for greater individual goals in treatment for depression and schizophrenia. High ISC teachers also reported greater perception of interpersonal control and emotional support, less dependency and less interpersonal sensitivity than lower ISC teachers. Little support was found for the commonly observed somatization of distress among non-Western peoples.

Cue-Controlled Relaxation and “Aromatherapy” in the Treatment of Speech Anxiety

The purpose of this investigation was to examine the separate and combined effects of cue-controlled relaxation training and “aromatherapy” as treatments for reducing speech anxiety. Thirty-six speech anxious subjects were randomly assigned to one of four conditions: cue-controlled relaxation with a word cue, cue-controlled relaxation with an aroma cue, “aromatherapy” alone, and a wait list (i.e., control) group. Prior to treatment, subjects completed the Personal Report of Confidence as a Speaker, Fear of Negative Evaluation questionnaire, S-R Inventory of Anxiousness-Speech Form, Cognitive Somatic Anxiety Questionnaire, and Multiple Affect Adjective Check List; subjects also performed a speech which was rated for behavioral signs of anxiety. The assessment protocol was repeated following treatment, and at a two-month follow-up. Thirty-two of 36 subjects (89%) provided complete data at post-treatment, and 23 of 28 treated subjects (82%) provided complete data at follow-up. Results indicated that subjects in both cue-controlled relaxation conditions decreased their speech anxiety more than did the subjects in the aromatherapy or control conditions.

The Minnesota multiphasic personality inventory hypochondriasis scale: its relation to bodily awareness and irrational beliefs

The present study evaluated whether the Minnesota Multiphasic Personality Inventory Hypochondriasis Scale (MMPI Hs) assesses actual awareness of and anxiety about bodily sensations rather than irrational assumptions. One hundred and thirty three undergraduate subjects completed the MMPI Hs, the Cognitive-Somatic Anxiety Questionnaire (CSAQ), Body Consciousness Questionnaire (BCQ) and Irrational Beliefs Scale (IBS). There were significant correlations between all the measures with the exception of the MMPI Hs and IBS. Thus, in line with previous suggestions the MMPI Hs seems to assess actual somatic awareness and its use as a measure of hypochondriasis is questionable.

Self report assessment of anxiety: A cross validation of the lehrer woolfolk anxiety symptom questionnaire in three populations

This study was meant to investigate the psychometric properties and clinical utility of the Lehrer Woolfolk Anxiety Symptom Questionnaire (LWASQ), an instrument for assessment of somatic, behavioral and cognitive aspects of anxiety. Confirmatory factor analysis on data from social phobies ( n = 108), normal adults ( n = 103) and normal adolescents ( n = 650) showed that the three original factors were strongly replicated in each sample. The three subscales appeared to have high internal consistency, while data on convergent and divergent validity were satisfactory. In addition, the subscales did very well in discriminating between phobic patients and normals, and were able to detect treatment effects. In the discussion the instrument is compared with other self report measures of anxiety dimensions, like the Cognitive Somatic Anxiety Questionnaire (CSAQ) and the Worry-Emotionality Scale (WES). It is suggested that similar questionnaires, adjusted to the separate anxiety disorders, should be developed.

Profiles of DSM III anxiety disorders on the somatic, cognitive, behavioural and feeling components of the four systems anxiety questionnaire

This paper presents a comparison of the component profiles of the Four Systems Anxiety Questionnaire (FSAQ), Three Systems Anxiety Questionnaire (TSAQ) and cognitive Somatic Anxiety Questionnaire (CSAQ) for agoraphobia, social phobia, simple phobia, generalized anxiety disorder, panic disorder and obsessional—compulsive disorder patient groups. The relationship between cognitive and affect components of the FSAQ for each diagnostic group is presented with special regard to the obsessive—compulsive group. Results indicate that the FSAQ is sensitive to differential loadings of each of the anxiety diagnostic groups. In addition the obsessional—compulsive group produced a significantly higher cognitive than affect component and this difference was greater than for the other diagnostic groups. The clinical relevance of the FSAQ as an assessment measure is discussed.

Cognitive and somatic anxiety

Three hundred and forty adults (including sports players, recreational exercisers, meditators and sedentary controls) completed three inventories purporting to measure cognitive and somatic aspects of anxiety. These were the Cognitive-Somatic Anxiety Questionnaire (CSAQ) devised by Schwartz, Davidson & Goleman ( Psychosomatic Medicine, 40, 321–328, 1978), the Worry-Emotionality Scale (WES, Morris, Davis & Hutchens. Journal of Educational Psychology, 73, 541–555, 1981) and the Lehrer-Woolfolk (1982) Anxiety Symptom Questionnaire (LWASQ). Factor analysis of the CSAQ and WES identified distinct cognitive and somatic anxiety factors in both inventories. Higher somatic than cognitive ratings were recorded on the CSAQ and WES, while the pattern was reversed on the LWASQ. The CSAQ can tentatively be recommended as a useful measure of these two anxiety components. We were unable to confirm an observation made previously in the literature that practice of meditation is associated with reduced cognitive anxiety, or that exercise is linked with lower somatic anxiety.

Factor analysis of the cognitive-somatic anxiety questionnaire

The Cognitive-Somatic Anxiety Questionnaire (CSAQ; Schwartz, Davidson, & Goleman, 1978) is a brief self-report rating scale designed to differentiate between cognitive and somatic symptoms of anxiety. The CSAQ gained relatively widespread acceptance as a behavioral assessment instrument before much was known about its psychometric properties. Psychometric studies of the CSAQ (e.g., DeGood & Tait, 1987) have raised questions about the instrument's item content and subscale structure. The primary purpose of the present study was to determine whether the Cognitive and Somatic subscales correspond to the instrument's factorial structure in a clinically anxious population. The sample consisted of 120 nonpsychotic psychiatric inpatients. Factor analysis with oblique rotation accounted for 60% of the total variance and yielded four factors that do not conform to the Cognitive-Somatic subscale structure. The results challenge the validity of the CSAQ and suggest the need for an improved instrument capable of differentiating the multidimensional features of clinical anxiety.

The cognitive-somatic anxiety questionnaire: Psychometric and validity data

The Cognitive-Somatic Anxiety Questionnaire (CSAQ) is a 14-item self-report inventory that is divided into two 7-item scales (Cognitive and Somatic) that appear to reflect cognitive or somatic anxiety. In an attempt to evaluate the construct validity of this multidimensional instrument, the CSAQ was administered to 109 college students along with several other measures of physical and psychological symptoms. The results suggest that (a) despite considerable overlap between the Cognitive and the Somatic scales (r=.62), an exploratory factor analysis is able to identify a single large somatic factor along with three lesser cognitive-appearing factors, and (b) the correlations with concurrent measures of related constructs provide some limited evidence of the construct validity of the CSAQ. For males, both the Cognitive and the Somatic scales of the CSAQ correlated significantly with several anxietyrelated measures. However, for females CSAQ scores correlated less consistently with the other test scales, although Somatic scale scores for females were positively related to measures of health and exercise involvement. Suggestions for improving the CSAQ are offered.

The anxiety sensitivity index:: Construct validity and factor analytic structure

Reliability, factor structure, and factor independence from other anxiety measures for the Anxiety Sensitivity Index (ASI) was assessed. One hundred and twenty-two anxious college students were administered the ASI, Cognitive-Somatic Anxiety Questionnaire, and the Reactions to Relaxation and Arousal Questionnaire. The results suggest that the ASI is a reliable measure which is factorially independent of other anxiety measures. Further, the ASI was supported as a measure of the variable anxiety sensitivity which has been suggested as an important personality variable in fear behavior.

The factor structure of the cognitive-somatic anxiety questionnaire

The factor structure of the Cognitive-Somatic Anxiety Questionnaire (CSAQ) was examined in a sample of 227 students. Results from factor-analytic procedures indicated that the main dimensions of the test are a cognitive factor and a somatic factor, although the items do not fall as cleanly into these factors as was predicted a priori. The results are discussed in terms of the importance of differentiating cognitive and somatic anxiety at a theoretical and measurement level. It was concluded, however, that a better scale for these purposes could be constructed.

Predictive validity of the CognitiveVs. Somatic Anxiety Distinction

The purpose of this study was to test the predictive validity of an instrument, The Cognitive-Somatic Anxiety Questionnaire (CSAQ), which purports to measure separately cognitive and somatic anxiety. Twelve subjects with either predominantly cognitive or somatic anxiety received a treatment that matched their predominant anxiety mode ("matched"), and twelve received a treatment which addressed the secondary anxiety mode ("mismatched"). After five sessions, the "matched" subjects reported significantly fewer anxiety symptoms than the "mismatched" subjects. The results support the predictive validity of the CSAQ, and suggest that anxiety may not be a unidimensional phenomenon. The implications of these results for clinical practice are discussed.

Characteristics of subjects experiencing relaxation and relaxation-induced anxiety

The purpose of this study was to determine the psychological characteristics of people who show a paradoxical increase in anxiety during relaxation training. Thirty-eight subjects who reported being anxious 50% or more of the day, were divided into two groups based on their scores on the Tellegen and Atkinson absorption scale. Half of each group was given progressive muscle relaxation training; the other half a meditational procedure. Separate regression analyses for each group showed that during meditational procedure 32% of the change in heartrate and 42% of the change in a subjective response measured by changes in the position of an “anxiety lever”, could be predicted by the subjects' scores on the Tellegen absorption scale, the cognitive component of the state version of the Cognitive-Somatic Anxiety Questionnaire, and other psychological tests. Similarly, 49% of the heartrate changes during progressive muscle relaxation training were predicted by these and other measures. The multiple R for anxiety lever during progressive muscle relaxation training was not significant, however. Three of 18 meditational procedure subjects and two of 20 progressive muscle relaxation subjects showed increased heartrates during relaxation training. Two of the three meditational procedure subjects also showed an increase in subjective tension as measured by the anxiety lever.

Specific modes of anxiety and arousal

Although it may be oversimplistic to regard the cognitive and behavioral effects of anxiety as simply being due to associated increases in arousal, this is essentially what many theories of anxiety do. Indeed, some theorists go so far as to equate anxiety with arousal. This experiment questions the appropriateness of this assumption by showing that increases in arousal do not necessarily accompany increases in anxiety. First, a 14-item arousal questionnaire was validated using factor analytic and multivariate analysis of variance techniques. Two factors were identified: cognitive activation and somatic activation. The validated questionnaire was then administered to eight very experienced rock-climbers in six different environments, together with a cognitive-somatic anxiety questionnaire. Heartrate and oral temperature were also measured. The six environments were: morning and evening; during a prolonged “bouldering” session; and immediately prior to leading pitches at two grade, one grade and zero grades below their leading capacity. The experimental hypothesis that activation would be increasingly impaired in the latter two conditions while anxiety would continue to increase, was confirmed by a multivariate analysis of variance (p<0.001). The results are interpreted as supporting the sort of two-factor theory of arousal that has been proposed by Gray.

Gender differences on the Cognitive-Somatic Anxiety Questionnaire.

Recently the Cognitive-Somatic Anxiety Questionnaire has seen renewed use in the study of differential effectiveness of relaxation techniques in the amelioration of anxiety, yet few normative data exist. To explore several methodological limitations of a prior study in which the questionnaire was introduced, the present work assessed 123 college students. Gender differences appear on the subscales and the directions of the differences question work upon which the test was based. Further validation is required.