Fear Questionnaire Research Articles

Screening for anxiety in an epidemiological sample: predictive accuracy of questionnaires

The study examined the predictive accuracy of selected questionnaires when screening for anxiety in a representative epidemiological sample of young female adults ( N=1877). All participants were diagnosed using a structured diagnostic interview. Anxiety questionnaires included global as well as specific measures (Beck Anxiety Inventory (BAI), Symptom Checklist, Anxiety Sensitivity Index (ASI), Fear Questionnaire (FQ), Mobility Inventory (MI)). Sensitivity, specificity, positive and negative predictive power were computed for two screening decisions: (1) identifying any anxiety disorder or (2) identifying a specific anxiety disorder (agoraphobia) within the total sample and the clinical subsample. Due to naturalistic (low) base rates in epidemiological samples, diagnostic indices were lower than those previously reported. However, questionnaire data proved useful when a specific disorder was targeted (agoraphobia) and specific symptoms were operationalized.

The Koala Fear Questionnaire: Its Relationship with Fear of Storms and Hurricanes in 4- to 14-Year-Old Antillean Children

The present study further investigated the reliability and validity of the recently developed Koala Fear Questionnaire (KFQ) in a large sample of 4- to 14-year-old school children (N = 378) who lived on Sint-Maarten, The Netherlands Antilles. The results confirmed that the KFQ is a reliable scale with good internal consistency. Furthermore, evidence was obtained for the concurrent validity of the scale. That is, KFQ scores were substantially correlated with a highly relevant fear of the children on Sint-Maarten, namely fear of storms and hurricanes. Finally, psychometric properties in the younger children of our sample were highly similar to those obtained in older children. Altogether, these findings provide further support for the notion that the KFQ is a reliable and valid scale for assessing fears and fearfulness in children aged 4 years and above.

The connection between cognitive development and specific fears and worries in normal children and children with below-average intellectual abilities: a preliminary study

The present study explored the relationship between cognitive development and anxiety phenomena in 4–12-year-old children. Fears and worries of normal children ( n=176) were compared to those of children with below-average intellectual abilities (children with BAIA; n=105). We evaluated to what extent level of cognitive development as indexed by a Piagetian conservation task was associated with the presence of fears and worries. While normal children and children with BAIA did not differ with regard to the content of their fears and worries, normal children more frequently reported such anxiety phenomena during the semi-structured Anxiety Interview than did children with BAIA. Furthermore, in normal children, evidence was found to suggest that level of cognitive development contributes to the experience of fears and worries. That is, anxiety phenomena were more prevalent among those children who passed a Piagetian conservation task. However, when anxiety phenomena were assessed by means of the Koala Fear Questionnaire (KFQ), a different picture emerged. KFQ data suggested that fears were less frequent in normal children and those children with BAIA who had a higher level of cognitive functioning. Apparently, the Anxiety Interview and the KFQ tap quite different aspects of anxiety. The KFQ seems to measure primitive fears that are likely to be prevalent among children with limited cognitive capacity, whereas the Anxiety Interview assesses more sophisticated anxiety phenomena that probably depend on high levels of cognitive functioning.

Sertraline Treatment of Generalized Social Phobia: A 20-Week, Double-Blind, Placebo-Controlled Study

The authors evaluated the efficacy, safety, and tolerability of sertraline, a selective serotonin reuptake inhibitor, in the treatment of generalized social phobia. Adult outpatients with generalized social phobia (N=204) from 10 Canadian centers were randomly assigned to receive sertraline or placebo in a 2:1 ratio for a 20-week double-blind study following a 1-week, single-blind, placebo run-in. The initial dose of sertraline was 50 mg/day with increases of 50 mg/day every 3 weeks permitted after the fourth week of treatment (dosing was flexible up to a maximum of 200 mg/day). Primary efficacy assessments were the percentage of patients rated much or very much improved on the Clinical Global Impression (CGI) improvement item and the mean changes from baseline to study endpoint in total score on the social phobia subscale of the Marks Fear Questionnaire and total score on the Brief Social Phobia Scale. In intent-to-treat endpoint analyses of 203 of the patients, significantly more of the 134 patients given sertraline (N=71 [53%]) than of the 69 patients receiving placebo (N=20 [29%]) were considered responders according to their CGI improvement scores at the end of treatment. The mean reductions in the social phobia subscale of the Marks Fear Questionnaire and in the total score on the Brief Social Phobia Scale were 32.6% and 34.3% in the sertraline group and 10.8% and 18.6% in the placebo group, respectively. Analysis of covariance showed superiority of sertraline over placebo on all primary and secondary efficacy measures. Sertraline was well tolerated: 103 (76%) of the 135 sertraline-treated patients and 54 (78%) of the 69 placebo-treated patients completed the study. Sertraline is an effective treatment for patients with generalized social phobia.

Psychometric comparability of English- and Spanish-language measures of anxiety and related affective symptoms.

An array of measures of anxiety and related disorders (viz., Albany Panic and Phobia Questionnaire; Anxiety Sensitivity Index; Beck Anxiety Inventory; Beck Depression Inventory-II; Body Sensation Questionnaire; Fear Questionnaire; Padua Inventory; Penn State Worry Questionnaire; Post-Traumatic Stress Disorder Diagnostic Scale; Social Interaction Anxiety Inventory; and Worry Scale) was edited or translated from English into Spanish. Following an extensive edit and translation process, bilingual participants (n = 98) were assessed with the English and Spanish versions of these measures. Coefficient alphas were excellent and comparable across language versions. Means and standard deviations were also comparable across language versions. Evidence of convergent and discriminant validity was found for both language versions. The two language versions of each measure correlated highly with each other. This psychometric comparability adds confidence in using the newly edited or translated Spanish language measures in clinical practice and research.

Assessing older adults with generalized anxiety: a replication and extension

Anxiety is a major health problem for older adults. The cornerstone for further work in this area is research that establishes the psychometric utility of standardized measurement strategies to characterize anxiety in older adults. The goals of the current study were to replicate and extend prior research addressing the psychometric properties of five self-report measures of anxiety in a sample of 57 older adults with generalized anxiety disorder (GAD). Data addressed the descriptive characteristics, internal consistency, test–retest reliability, interrelation of subscales, and convergent and divergent validity of the Penn state worry questionnaire (PSWQ), worry scale (WS), Spielberger state-trait anxiety inventory — Form Y (STAI), and two versions of the fear questionnaire (FQ). Descriptive data generally replicated prior findings, with some increased state and trait anxiety in the current sample. Measures were internally consistent, with evidence that a revised version of the FQ that focuses on severity of fear irrespective of associated avoidance demonstrated greater internal consistency than the original version. Measures of content-specific fears and worries (WS, FQ) were stable over time and demonstrated convergent validity. Evidence of convergent validity also was evident for measures of worry and general anxiety (WS, PSWQ, STAI-Trait), but two of these measures (PSWQ, STAI) were not reliable over time. Only the PSWQ showed evidence of divergent validity with respect to self-report measures of depression.

Disgust and psychopathological symptoms in a nonclinical sample

There is little doubt that disgust sensitivity plays a role in the development of small animal phobias. However, it has been suggested that the basic emotion of disgust is implied in a broad range of psychopathological conditions. The present study examined the relationship between disgust sensitivity and symptoms of phobias (other than animal phobias), obsessive-compulsive disorder, depression, and eating disorder in a nonclinical sample. Undergraduate psychology students were asked to complete the Disgust Sensitivity Questionnaire, as well as measures of phobic (Fear Questionnaire), obsessive-compulsive (Maudsley Obsessive-Compulsive Inventory), depressive (Beck Depression Inventory), and eating disorder (Restraint Scale) symptomatology. Results showed that disgust sensitivity was only related to symptoms of agoraphobia and obsessive-compulsive disorder. The present findings cast doubts on the idea that disgust sensitivity is a central factor underlying a broad range of psychopathological conditions.

CHANGES IN APPEARANCE AND PSYCHOSIS

Anecdotal reports suggest that drastic changes in physical appearance may signal decompensation in schizophrenic patients. The current study sought to explore the association between changes in appearance and psychotic vulnerability in a systematic fashion. 171 undergraduates completed the Physical Appearance Scale (PAS) that assesses frequency and nature ofchanges in outlooks, along with a Schizotypy Scale (STA), the Maudsley Obsessive Compulsive Inventory (MOCI), the Fear Questionnaire (FQ), and the Beck Depression Inventory (BDI). A modest but significant correlation was found between Physical Appearance Scale scores and STA-scores. For the other symptom measures (i.e. MOCI, FQ and BDI), no association with changes in physical appearance emerged. The findings suggest that drastic changes of the physical are specifically linked to schizotypal dispositions and may point to a underlying vulnerability for developing schizophrenia. The clinical implications of the connection between marked changes in outlooks and psychosis are addressed.

The characteristics of patients given antidepressants while recovering from critical illness

Antidepressants are occasionally given to recovering intensive care (ICU) patients, either while in ICU, or shortly afterwards on the ward. However there is little research on what characterizes these patients or their longer term psychological recovery. As part of a larger rehabilitation study data were collected on the characteristics of ICU patients receiving antidepressants while in hospital and their progress up to 6 months post ICU. Recovering ICU patients were approached once it was clear the patient was expected to survive to 6 months. A record was made of antidepressant medication and depression was assessed using the Hospital Anxiety and Depression Scale (HAD). Psychological recovery was assessed at 2 and 6 months post ICU using the HAD1 and the Fear questionnaire2 to record panic attacks/phobias and physical recovery was similarly recorded using the SF-36. Seventy-six patients completed the HAD at 2 weeks, 2 months and 6 months post ICU. All the patients had been intubated and had had an ICU stay ≥48 h, 18 had received antidepressants either in the ICU or shortly afterwards on the ward for a clinical diagnosis of depression. Patients receiving antidepressants were much more likely to have had a longer ICU stay and a longer hospital stay (see Table 12). The fear questionnaire scores were not related directly to the length of ICU stay. The questionnaire allows the examination of which particular areas patients are having difficulty with. Patients receiving antidepressants were becoming panicky travelling alone, being alone in a busy street or far from home, and going shopping alone. The data suggest that the use of antidepressants at times may be inappropriate. The difficulty of establishing the diagnosis of depression in ICU may mean that only soft clinical criteria are used. This is more likely to occur in longer stay patients. Passivity due to a learned helplessness state may be diagnosed as depression while patients are intubated. This would fit with these patients having difficulty performing activities alone. Alternatively a subdued anxiety state may be similarly being misdiagnosed as depression.

Drinking away the hurt: the nature and prevalence of PTSD in substance abuse patients attending a community-based treatment program

The prevalence of posttraumatic stress disorder (PTSD) was evaluated in 91 participants attending a community-based substance abuse program. The participants were classified as having PTSD, possible PTSD, or no PTSD using the modified PTSD symptom scale (MPSS; Falsetti, Resnick, H. S., Resnick, P. A. & Kilpatrick, 1993). These groups were then compared on measures of anxiety, depression, and fear using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Anxiety Sensitivity Index (ASI), and the Fear Questionnaire (FQ). The results showed that 52.8% of participants had either PTSD (37.4%) or possible PTSD (15.4%). Findings also showed that those with PTSD experienced more potentially traumatic events (e.g., rape, being beaten-up) compared to the possible PTSD and no PTSD participants. The PTSD group also reported significantly greater scores on the ASI, BAI, and BDI than did the no PTSD group, and greater scores on the ASI and BAI than did the possible PTSD group. Further, when using a discriminant function analysis, self-report measures correctly classified 70% of the PTSD group and 80% of a composite group of possible PTSD and no PTSD participants. Implications of these results are discussed.

Phobic nature of social difficulty in facially disfigured people.

Over 390,000 people in the UK are disfigured. Facial disfigurement distresses sufferers markedly but has been studied little. To compare fearful avoidance of people with a facial disfigurement with that of a group of patients with phobia. Comparison of Fear Questionnaire agoraphobia, social phobia and anxiety depression sub-scale scores of 112 facially disfigured people (who scored high on Fear Questionnaire problem severity in three survey studies) with those of 66 out-patients with agoraphobia and 68 out-patients with social phobia. Facially disfigured people and patients with social phobia had similar Fear Questionnaire scores. In contrast, facially disfigured people scored lower on the agoraphobia sub-score but higher on the social phobia sub-score than did patients with agoraphobia. Facially disfigured people with psychological difficulties resembled people with social phobia on Fear Questionnaire social phobia, agoraphobia and anxiety/depression sub-scores but were less agoraphobic and more socially phobic than were people with agoraphobia. Facially disfigured people thus appeared to be socially phobic and to deserve the cognitive--behavioural therapy that is effective for such phobias.

Controlled comparison of computer-aided vicarious exposure versus live exposure in the treatment of spider phobia

Forty-five participants diagnosed as having specific phobia of spiders were randomly assigned to one of three treatment groups: (a) computer-aided vicarious exposure; (b) therapist-delivered live exposure; (c) relaxation placebo. Each group received three 45-minute sessions. Phobic symptom severity was measured at pretreatment, post-treatment, and at a 3-month follow-up assessment with the Spider Questionnaire, Fear Questionnaire, Phobic Targets and Work Adjustment Ratings Scale, and a Behavioral Assessment Test with Subjective Units of Distress Rating Scale. The results showed that the computer-aided vicarious exposure was an effective treatment for spider phobia and comparable to live exposure therapy in significantly reducing phobic symptoms. Both the computer and live exposure treatments were more effective than the relaxation placebo treatment.

Assessment of anxiety in older adults: a community-based survey and comparison with younger adults

The reliability and validity of existing anxiety self-report scales in elderly adults has not been adequately established, and the phenomenology of anxiety in older adults is largely unknown. In the present study, three anxiety scales and measures of depression and somatization were used to compare symptoms between older ( n=84, mean age=75.3) and younger ( n=48, mean age=40.3) community-dwelling adults. Results showed that the anxiety scales demonstrated good internal consistency in both age groups, although the reliabilities of the Fear Questionnaire subscales ranged from poor to good. Convergent and divergent validity were found to be variable in the older group, but this may reflect differences in anxiety as it occurs in older persons rather than psychometric problems. Anxiety symptoms did not vary with age, and levels of anxiety also remained constant. However, gender differences were found only within the older age group, with women reporting more anxiety than men. Findings are discussed with respect to current conceptualizations of anxiety in older people, as well as implications for future research.

Psychometric properties of the Accident Fear Questionnaire: An analysis based on motor vehicle accident survivors in a rehabilitation setting.

Psychometric properties of the Accident Fear Questionnaire: An analysis based on motor vehicle accident survivors in a rehabilitation setting.

A comparison of people with and without nocturnal panic attacks

This study examined differences in frequency and severity of diurnal panic attacks between patients with ( n=22) and without ( n=21) a history of nocturnal panic attacks. Subjects were assessed with a modified version of the SCID, and completed daily panic attack diaries, the Anxiety Sensitivity Index, and the Fear Questionnaire. No differences were found between the groups in the actual number of expected or unexpected diurnal panic attacks experienced. Subjects in the nocturnal panic group experienced significantly more symptoms during diurnal panic attacks than did the diurnal only group. More specifically, the nocturnal panic group experienced more symptoms during expected diurnal panic attacks, but not during unexpected/spontaneous diurnal panic attacks. A greater proportion of the nocturnal panic subjects reported “chest pain” during diurnal panic attacks and a trend toward greater “fear of dying”. Otherwise, the two groups were very similar. Implications of the findings are discussed in relation to the findings of other recent studies of nocturnal panic.

Confirmatory factor analysis of the Fear Questionnaire in injured workers with chronic pain.

In an effort to extend the validity of the Fear Questionnaire (FQ) in a sample of patients with high levels of blood/injury phobia, the FQ responses of 255 injured workers with chronic pain were subjected to confirmatory factor analysis. Results indicated that an intercorrelated three-factor model of the FQ provided a better fit to the data than unidimensional, two-factor, hierarchical three-factor, or categorical three-factor models. These findings provide further support for the factorial validity of the FQ and the corresponding multidimensional theory of fear.

Psychometric properties of the Accident Fear Questionnaire: An analysis based on motor vehicle accident survivors in a rehabilitation setting.

Psychometric properties of the Accident Fear Questionnaire: An analysis based on motor vehicle accident survivors in a rehabilitation setting.

The differential effect of personality on computer-based treatment of agoraphobia

The differential effects of the revised NEO Personality Inventory INEO PI-R) personality factors and intelligence on response to a computerized vicarious exposure treatment for agoraphobia were investigated. The Fear Questionnaire (FQ), the Agoraphobia Cognitions Questionnaire (ACQ), and the Body Sensations Questionnaire (BSQ) were used to assess agoraphobic symptomatology. Fourteen females and four males with agoraphobia diagnoses completed three 45-minute weekly treatment sessions. There was a significant decrease in scores on all three measures following treatment. Compared with published population norms, the agoraphobic subjects showed very high neuroticism, low extroversion, and high openness. Lower agreeableness factor scores predicted good treatment outcome. The NEO PI-R openness factor was negatively correlated with proficiency on the computer program; however, proficiency on the computer program did not correlate with symptom improvement. Overall, these results suggest that personality interacts with treatment at different stages of the therapeutic process.

Determining the Effectiveness of a Short-Term Anxiety Management Course

The effectiveness of a 6-week anxiety management course at a mental health day hospital was researched. The author was motivated to research these sessions due to her own observations of the clients' progress in the groups. There was also an increasing demand for anxiety management groups with many clients being referred by general practitioners. The subjects were 37 clients. The diagnosis of the clients varied but anxiety must have been identified as a problem. Four of the 6-week courses were run over a period of 10 months. The course was evaluated using three questionnaires: the Hospital Anxiety and Depression (HAD) Scale, the Spielberger Questionnaire (state and trait) and the Fear Questionnaire. The clients completed the questionnaires four times: pre-treatment, at the beginning and at the end of the course, and at 2 months post-treatment. A control group was used. The data collected from the questionnaires were analysed using paired t-tests. The results showed that the anxiety management course was effective, with a statistically significant reduction in symptoms by the end of the course. The control group did not show significant change. It was the HAD Scale that showed the statistically significant positive change. The state section of the Spielberger Questionnaire followed the same pattern as the HAD Scale and showed a reduction in symptoms, although it was not statistically significant. The results of the Fear Questionnaire suggested that the clients' phobias were not treated by the anxiety management course. A client satisfaction questionnaire was used and participants made positive comments about the value of the course.

Sensitivity of Outcome Measures for Treatments of Generalized Social Phobia

To accurately evaluate treatments of generalized social phobia, it is not sufficient that measures be reliable and valid, they also must be sensitive to treatment-related changes. The present study evaluated the sensitivity of the following five measures: (a) The Social Phobia scale from the Social Phobia and Anxiety Inventory (SPAI-SP), (b) the SPAI difference score (SPAI-D), (c) the short form of the Fear of Negative Evaluation Scale (FNE-S), (d) the Social Phobia scale from the Fear Questionnaire (FQ-SP), and (e) peak anxiety during an impromptu speech task. Unmedicated people with generalized social phobia ( N = 60) were randomly allocated to one of the following two treatments: (a) eight sessions of associative therapy (AT; i.e., free association to socially relevant thoughts and memories), followed by eight sessions of in vivo exposure (EXP); or (b) eight sessions of cognitive restructuring (CR), followed by eight sessions of EXP. Outcome measures were completed on entry into the study, after completing AT or CR (post-I), after completing EXP (post-II), and at 3-month follow-up. For each outcome measure, effect sizes were computed for post-I, post-II, and follow-up. The SPAI-SP and SPAI-D tended to have the largest effect sizes, and the FNE-S and FQ-SP tended to yield the smallest effects. The results add to the growing body of research supporting the usefulness of the SPAI scales as a treatment-outcome measure for studies of generalized social phobia.