Marked Fear Research Articles

Self-Focused Cognition in Social Anxiety: A Review of the Theoretical and Empirical Literature

Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social or performance situations. Cognitive models suggest that self-focused cognitive processes play a crucial role in generating and maintaining social anxiety, and that self-focused cognition occurs prior to, during, and following social situations (Clark & Wells, 1995; Rapee & Heimberg, 1997). There is a substantial body of empirical evidence demonstrating that socially anxious individuals engage in self-focused cognition during and following a social or performance situation. A smaller but growing body literature suggests that a similar process occurs prior to such situations, and that these three processes are interdependent. Furthermore, the vast majority of research to date indicates that self-focused cognitive processes are detrimental, and that they generate and maintain social anxiety in a variety of ways. However, there remains considerable scope for research to further explicate the role of these processes in the maintenance of SAD, and to enhance interventions designed to ameliorate their negative effects.

DSM-5 and the Assessment of Childhood Anxiety Disorders: Meaningful Progress, New Problems, or Persistent Diagnostic Quagmires?

Having passed the one-year anniversary of the initial DSM-5 publication, this paper presents a guiding summary of key areas of change—and lack thereof—across DSM definitions of disorders affecting anxious youth, and offers data-informed evaluations and commentaries clarifying the areas in which DSM-5 should be celebrated as a meaningful advancement in the assessment of child anxiety, diagnostic dilemmas in child anxiety assessment from previous DSM editions that remain unresolved in DSM-5, and areas in which DSM-5 may have actually introduced new problems into the assessment of child anxiety. We organize our review and commentary around five of the meaningful changes in DSM-5 with implications for the assessment of anxious youth: (1) the new classification of selective mutism as an anxiety disorder; (2) the removal of the social anxiety disorder “generalized” specifier and the new addition of a “performance-only” specifier; (3) the revised operationalization of agoraphobia and the decoupling of agoraphobia from panic disorder; (4) the creation of a new category—disruptive mood dysregulation disorder—for diagnosing youth presenting with chronic irritability and severe temper outbursts; and (5) the revised classification of anxiety disorders not otherwise specified in the DSM. We then turn our attention to discuss four areas of noted diagnostic dilemmas in the assessment of child anxiety from DSM-IV that remain unresolved in the new DSM-5: (1) the phenomenological overlap between the OCD and generalized anxiety disorder (GAD) definitions; (2) the phenomenological overlap between GAD and major depressive disorder (MDD) definitions; (3) differential diagnostic utility across the separation anxiety disorder symptoms; and (4) the extent to which youth presenting with multiple marked and persistent fears should be assigned multiple distinct diagnoses of specific phobia.

Effects of post-session administration of methylene blue on fear extinction and contextual memory in adults with claustrophobia.

Preclinical studies have shown that low-dose methylene blue increases mitochondrial cytochrome oxidase activity in the brain and improves memory retention after learning tasks, including fear extinction. The authors report on the first controlled experiment to examine the memory-enhancing effects of posttraining methylene blue administration on retention of fear extinction and contextual memory following fear extinction training. Adult participants displaying marked claustrophobic fear were randomly assigned to double-blind administration of 260 mg of methylene blue (N=23) or administration of placebo (N=19) immediately following six 5-minute extinction trials in an enclosed chamber. Retesting occurred 1 month later to assess fear renewal as indexed by peak fear during exposure to a nontraining chamber, with the prediction that the effects of methylene blue would vary as a function of fear reduction achieved during extinction training. Incidental contextual memory was assessed 1 and 30 days after training to assess the cognitive-enhancing effects of methylene blue independent of its effects on fear attenuation. Consistent with predictions, participants displaying low end fear posttraining showed significantly less fear at the 1-month follow-up if they received methylene blue posttraining compared with placebo. In contrast, participants displaying moderate to high levels of posttraining fear tended to fare worse at the follow-up if they received methylene blue posttraining. Methylene blue's enhancement of contextual memory was unrelated to initial or posttraining claustrophobic fear. Methylene blue enhances memory and the retention of fear extinction when administered after a successful exposure session but may have a deleterious effect on extinction when administered after an unsuccessful exposure session.

What we do and don't know about sex offenders' intimacy dispositions

Abstract Despite the significant role attributed to intimacy deficits in the etiology of sexual offending, current understanding of sex offenders' intimacy dispositions remains limited. The present article reviews the theoretical and empirical literature in order to better define the intimacy dispositions of sex offenders, and understand the role of intimacy in sexual offending. Research on sex offenders evidences a marked fear of intimacy and a low involvement in practices that can lead to intimacy, which suggests a poor inclination for the experience of intimacy. Moreover, scarce available data show that aspects of intimacy increase sex offenders' susceptibility to adopt sexually abusive behaviors. Although research has suggested that intimacy deficits contribute to sexual offending behaviors, no common operationalizable definition of intimacy has yet been put forth. Consequently, our understanding of the components of intimacy and their specific etiological role in interpersonal functioning and in sexual offending lacks theorization and evidence-based research. The present article proposes to answer the following question: what are the intimacy deficits in sex offenders identified in the scientific literature, and what is the role of these deficits in sexually offending behaviors?

Identification of psychological dysfunctions and eating disorders in obese women seeking weight loss: cross-sectional study.

Objective. The aim of this study is to analyse associations between eating behaviour and psychological dysfunctions in treatment-seeking obese patients and identify parameters for the development of diagnostic tools with regard to eating and psychological disorders. Design and Methods. Cross-sectional data were analysed from 138 obese women. Bulimic Investigatory Test of Edinburgh and Eating Disorder Inventory-2 assessed eating behaviours. Beck Depression Inventory II, Spielberger State-Trait Anxiety Inventory, form Y, Rathus Assertiveness Schedule, and Marks and Mathews Fear Questionnaire assessed psychological profile. Results. 61% of patients showed moderate or major depressive symptoms and 77% showed symptoms of anxiety. Half of the participants presented with a low degree of assertiveness. No correlation was found between psychological profile and age or anthropometric measurements. The prevalence and severity of depression, anxiety, and assertiveness increased with the degree of eating disorders. The feeling of ineffectiveness explained a large degree of score variance. It explained 30 to 50% of the variability of assertiveness, phobias, anxiety, and depression. Conclusion. Psychological dysfunctions had a high prevalence and their severity is correlated with degree of eating disorders. The feeling of ineffectiveness constitutes the major predictor of the psychological profile and could open new ways to develop screening tools.

All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties Into Mental Disordersby HorwitzAllan V. Ph.D., and WakefieldJerome C. D.S.W., Ph.D. New York, Oxford University Press, 2012, 320 pp., $29.95.

All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties Into Mental Disordersby HorwitzAllan V. Ph.D., and WakefieldJerome C. D.S.W., Ph.D. New York, Oxford University Press, 2012, 320 pp., $29.95.

Fear of memories: the nature of panic in posttraumatic stress disorder

BackgroundAlthough there is increasing evidence that panic attacks are common in posttraumatic stress disorder (PTSD), little is known if posttraumatic panic is comparable to panic attacks observed in panic disorder (PD).ObjectiveThis study examined the cognitive responses to panic attacks in participants with PD and PTSD.MethodParticipants with PD (n=22) and PTSD (n=18) were assessed on the Anxiety Disorder Interview Schedule for DSM-IV and subsequently administered the Agoraphobic Cognitions Questionnaire and a measure of fears related to trauma memories.ResultsAlthough participants did not differ in terms of catastrophic appraisals about somatic sensations, PTSD participants were more likely to experience fears about trauma memories and being harmed by trauma again during their panic attacks than PD participants.ConclusionsThese findings suggest that although PTSD participants fear somatic outcomes during panic attacks, their panic attacks are distinguished by a marked fear of trauma memories.

Social anxiety score is high in adolescents with chronic migraine

Social anxiety disorder, also known as social phobia, is a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. It usually begins in mid-adolescence and has a chronic course and interferes in academic, social, family and personal functioning. Recent studies have shown that social anxiety disorder is more prevalent in adults with migraine. Little evidence on this subject is available for the adolescent population. This study was performed between August 2009 and August 2010; all patients were recruited in schools, pediatric or neuropediatric facilities, and were submitted to a detailed headache questionnaire, which consisted of demographic and clinical data. To evaluate social anxiety, the Social Phobia Inventory was used. A total of 151 subjects were evaluated: 50 had chronic migraine, 50 had episodic migraine and 51 were control subjects. In the chronic migraine group, the mean score in the Social Phobia Inventory was 18.5 ± 12.4, which was significantly higher than in the episodic migraine group (12.1 ± 8.1) and in the control group (13.8 ± 10.8; F(2131) = 4.8, P= 0.010). The mean score, however, was not significantly different between the control and episodic migraine groups. Chronic migraine is strongly associated with high social anxiety score, regardless of demographic data and pain intensity. The total burden of migraine may be increased with social anxiety disorder comorbidity.

Extreme fear of being laughed at: components of gelotophobia

The present study investigated individuals with slight, marked and extreme fear of being laughed at (gelotophobia) (Ruch and Proyer 2008a). Altogether 640 individuals filled in the GELOPH (Ruch and Proyer 2008b) online and 228 filled in a paper and pencil version. In both samples principal components analyses of the 15 items were computed for subgroups of individuals exceeding the cut-off point for slight gelotophobia (i.e., 2.5). All solutions between one and five factors were examined but a three-factor-solution seemed most preferable. These positively correlated components were interpreted as coping with derision (by control, withdrawal, internalizing), disproportionate negative responses to being laughed at, and paranoid sensitivity to anticipated ridicule. The latter two are seen specific to gelotophobia while the former might be shared with social anxiety in general. In the hierarchical factor analysis the more unspecific coping factor did split up further into three factors of control, withdrawal, and internalizing, while the two gelotophobia-specific factors stayed stable between the three- and five-factor solutions. These three factors yielded different correlational patterns. Coping with ridicule was higher among females and among the older while there were no differences for the other two factors. Furthermore, people reporting having been bullied were higher in defensive coping with ridicule and had stronger disproportionate negative responses to being laughed at than those who were not bullied. Results are discussed within a framework for future studies of individuals with higher levels of this fear. In particular, the computation of subscales is recommended when the focus lies on the extreme scorers.

Introduction to Special Issue on Social Phobia in Children

Social phobia (or social anxiety disorder) is characterised by ‘a marked and persistent fear of one or more social or performance situations’ (American Psychiatric Association, 1994). It is one of the most common forms of psychopathology, with a prevalence rate of around 7% in both children and adults (Furmark, 2002; Stein & Stein, 2008). Social phobia typically begins early in life, with approximately half of socially anxious adults reporting onset before the age of 11 (Stein & Stein, 2008). The significant impact of social phobia on the lives of children is increasingly recognised. For example, socially anxious children are less likely to have close friendships, and more likely to drop out of school early and are less liked by their peers than non-anxious children (La Greca & Lopez, 1998; Stein & Kean, 2000; Verduin & Kendall, 2008). Furthermore, if left untreated, social phobia during childhood increases risk for substance abuse and other mental health problems later in life (Crum & Pratt, 2001; Stein et al., 2001). Despite the prevalence and negative consequences of social phobia in children, understanding of the aetiology of this disorder remains limited. In this special issue, a series of papers are presented that take an experimental approach to further understanding of the pathogenesis of social phobia in children. As the ultimate goal of this experimental research is to contribute to the improvement of treatments for social phobia, the final paper presents a review of treatment research.

Efficacy of pregabalin in preventing relapse in patients with generalized social anxiety disorder

The objective of this study was to evaluate the efficacy and safety of pregabalin in preventing relapse in generalized social anxiety disorder (SAD). Patients with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) generalized SAD, who met responder criteria after 10 weeks of open-label treatment with fixed-dose pregabalin (450 mg/day; n=153), were randomly assigned to 26 weeks of double-blind treatment with pregabalin (450 mg/day) or placebo. The primary a-priori outcome of time to relapse was analyzed using the Kaplan-Meier method and the log-rank test. Double-blind treatment with pregabalin was associated with significant delay in time to relapse versus placebo (P=0.035), and with significantly greater maintenance of symptomatic improvement over 26 weeks on the Liebowitz Social Anxiety Scale total (P=0.012) and subscale scores and on the Marks Fear Questionnaire total phobia (P=0.010) and social phobia (P=0.014) subscales. Pregabalin was generally well tolerated. During the double-blind phase, the adverse events that occurred more frequently with pregabalin compared with placebo were dizziness (11.3 vs. 4.1%) and infection (21.3 vs. 16.4%). The results of this study suggest that pregabalin (450 mg/day) is safe, well tolerated, and has significant relapse-prevention efficacy over 26 weeks in patients with SAD who responded to an initial course of the pregabalin treatment.

Edgar Allan Poe, “The Pit and the Pendulum,” and Ventricular Assist Devices

ID: 66 Edgar Allan Poe, "The Pit and the Pendulum", and Ventricular Assist Devices Author Information: Authors List: Presenting Author: Cheryl Zambroski Additional Author: Pamela Combs Additional Author: Sherill Cronin Additional Author: Carol Pfeffer Presenting Author: Cheryl Hoyt Zambroski Address: University of South Florida College of Nursing 12901 Bruce B. Downs MDC 22 Tampa, FL 33647 USA Ph: 813-774-6436 Fax: Email: czambros@health.usf.edu Institution: University of South Florida Additional Author: Pamela S. Combs Address: University of Louisville 12901 Bruce B. Downs MDC 22 Louisville, KY 42092 USA Ph: 812-949-7289 Fax: Email: pscombs)1@louisville.edu Institution: University of Louisville Additional Author: Sherill N Cronin Address: Bellarmine University 12901 Bruce B. Downs MDC 22 Louisville, KY 40206 USA Ph: 502-425-5504 Fax: Email: scronin@bellarmine.edu Institution: Additional Author: Carol Pfeffer Address: Bellarmine University 12901 Bruce B. Downs MDC 22 Louisville, KY 40206 USA Ph: 502-425-5504 Fax: Email: scronin@bellarmine.edu Institution: Abstract InformationInformation Presentation Preference: SNRS Poster Presentation Abstract Categories: Interest Group: Researchers in Clinical Settings Thematic Areas: Chronic illness Introduction: Ventricular Assist Devices (VADs) are being used with increasing frequency in patients with heart failure. VADs are not without adversity, however, as high post-operative morbidity and mortality are of major concern. For those who survive, little is known about the experience from the patients' perspective. The purpose of this qualitative, descriptive study was to gain a better understanding of the experience of living with a VAD Method(s): Through the process of open-ended interviewing, data were collected and analyzed on an ongoing basis to generate conceptual categories. A key informant articulated his experience of living with a VAD through his analogy to Edgar Allen Poe's The Pit and the Pendulum. Furthermore, language of co-informants corresponded closely with themes emerging in Poe's short story. During analysis, a consultant from the English Department provided additional analysis of The Pit and the Pendulum as it related to each theme. Results: Six adults with an average age of 58.8 years participated. Both men were Caucasian; two women were Caucasian and two were African-American. There was wide variation in the length of device implantation. Four key themes: Facing the Unknown, Feeling Confined, Living with Fear, and Hope for the Future emerged. Discussion: Comparison of the experience of living with a VAD to the tale of Poe's Narrator does not provide an easy image for nurses who care for this population. Yet, diagnosis of heart failure can, in fact, be a sentence of sorts: a sentence to an uncertain future, physical decline, even to death. The findings of this study can help clinicians to target interventions toward reducing the uncertainty associated with living with a VAD, providing opportunities to reduce the sense of confinement, recognizing and reducing patient fears, and providing and supporting hope for the future through reduction of symptoms and extending life or through providing a peaceful death. Research Completed : Yes Abstract History: -This material has been presented or accepted for presentation in whole or in part at this or another scientific meeting. -Details: USF (local presentation) Financial Disclosure: Have a financial arrangement or affiliation with commercial companies whose products may be mentioned in this material? No FDA Disclosure: Cleared: Yes Non-Exclusive License: Accepted Terms: Yes Submitted By: czambros@health.usf.edu

Death attitude and changes of death image in the Hungarian society. Examination of generational value-judgment and possibilities of measurement. Is death still a taboo?

A dolgozat célja a halálhoz való viszonyulás szociológiai, antropológiai és pszichológiai aspektusainak elemzése, a különböző megközelítésmódok rendszerben való áttekintése, a megváltozott halálkép, illetve a változás tendenciájának bemutatása, a leginkább félelmet keltő faktorok vizsgálata és értelmezése a különböző nemi, kor- és foglalkozási csoportok tekintetében; halálfélelem és halál iránti attitűd kérdőívek validálása magyar populáción és a szorongást generáló halálfélelem oldása érdekében alkalmazott intervenciós lehetőségek áttekintése. Hipotézisünk szerint a nőkre erősebb halálfélelem és szorongás jellemző; a fiatalok jobban félnek a haláltól; az egészségügyi dolgozók halálfélelme magasabb a más foglalkozású személyekénél, munkájukból adódóan naponta szembesülnek a halál váratlan, bárkit utolérő voltával, és ez szorongáskeltő faktor. A halálfélelem és a halálhoz való viszonyulás pszichometriai méréséhez két, halálfélelmet, illetve halál iránti attitűdöt mérő skálát adaptáltunk és mértünk be magyar nyelven. Eredményeink alapján a Neimeyer- és Moore-féle Multidimenzionális Halálfélelem Skála és Lester Halál iránti Attitűd Skálája egyaránt validnak bizonyult, mindkét skála alkalmas a halálfélelem, illetve a halál iránti attitűd mérésére. Feltételezésünknek megfelelően a nőkre és a fiatal korosztályra nagyobb halálfélelem és szorongás jellemző. Az egészségügyi dolgozók csoportjánál a korábbi mérésekkel ellentétben alacsonyabb félelem-, illetve szorongásszintet tapasztaltunk.

The development and change of death image in Hungary. Differences in value judgement according to age and analysis of possible measurement methods. Is death still a taboo?

Abstract The aim of our research is to examine the sociological, anthropological, and psychological aspects of attitudes towards death, respectively reviewing the various approaches as a complex system; presenting the altered death image, respectively the change tendency, analysing and interpreting the most significant anxiety generating factors according to gender, age, and occupation; validating the fear of death and attitudes towards death scales in the Hungarian population; reviewing the possibilities for interventions designed to reduce anxiety generating fear of death. According to the hypotheses of our quantitative research, women are characterised by a marked fear of death and anxiety; young people are more afraid of death; health care workers have a higher level death anxiety in comparison to other professionals due to the fact that they face the suddenness and inevitability of death on a daily basis, and this in itself is an anxiety generating factor. For the psychometric measurement of fear of ...

Oseltamivir treatment for children showing abnormal behavior during influenza virus infection

We investigated the clinical courses of children with influenza infection, who showed abnormal behavior, who were treated with oseltamivir (Tamiflu ®). S ubjects: The subjects were 22 children, 2–15 (mean ± SD, 6.6 ± 3.2) years old, admitted to our hospital during the 2004–2005, 2005–2006, and 2006–2007 influenza seasons. Abnormal behavior appeared before treatment with oseltamivir in 13 children (pre-Tami group), and after administration of the medication in 9 (post-Tami group). All patients continued to receive oseltamivir for 3–5 days after admission. Results: Meaningless speech and movements without a specific purpose were the most frequent abnormal behavior (16 children), while illusions, delusions, and misidentifying awareness were the second most common (14 children). Sensations of marked fear and excitement were recognized in 6 children. One child rushed up and down the stairs unconsciously, raising concern that a serious accident might occur. All patients showed a favorable clinical course, without worsening of neurological symptoms or the development of encephalopathy, and outcomes were good. The clinical course, number of recurrences of abnormal behavior, and outcome were similar in the pre-Tami and post-Tami groups. Conclusions: Our observations suggest that oseltamivir is not a prerequisite for the development of abnormal behavior and does not worsen the clinical manifestations of abnormal behaviors, although further investigations are needed to determine whether oseltamivir is necessary, or even useful, for patients with influenza virus encephalopathy.

Facilitation of fear extinction in phobic participants with a novel cognitive enhancer: A randomized placebo controlled trial of yohimbine augmentation

Preliminary animal research suggests that yohimbine hydrochloride, a selective competitive alpha2-adrenergic receptor antagonist, accelerates fear extinction and converts ineffective extinction regimens (long intertrial intervals) to effective ones. This randomized placebo controlled study examined the potential exposure enhancing effect of yohimbine hydrochloride in claustrophobic humans. Participants (71% undergraduate students and 29% community volunteers) displaying marked claustrophobic fear ( n = 24) were treated with 2 1-h in vivo exposure sessions. Participants were randomly allocated to take 10.8 mg yohimbine hydrochloride ( n = 12) or placebo ( n = 12) prior to each exposure session. Outcome measures included peak fear during a behavioral avoidance task, the Claustrophobia Questionnaire, and the Claustrophobic Concerns Questionnaire. Results showed that both conditions improved significantly at post-treatment with no significant difference between groups. Consistent with prediction the group that took yohimbine hydrochloride prior to exposure sessions showed significantly greater improvement in peak fear at the one-week follow-up behavioral assessment ( d = 1.68). This was also true across other outcome measures with large to very large effect sizes. These data provide initial support for exposure enhancing effect of single-dose yohimbine hydrochloride in a clinical application.

Differential modulation of neural activity throughout the distributed neural system for face perception in patients with Social Phobia and healthy subjects

Social Phobia (SP) is a marked and persistent fear of social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. Faces of others are perceived as threatening by social phobic patients (SPP). To investigate how face processing is altered in the distributed neural system for face perception in Social Phobia, we designed an event-related fMRI study in which Healthy Controls (HC) and SPP were presented with angry, fearful, disgusted, happy and neutral faces and scrambled pictures (visual baseline). As compared to HC, SPP showed increased neural activity not only in regions involved in emotional processing including left amygdala and insula, as expected from previous reports, but also in the bilateral superior temporal sulcus (STS), a part of the core system for face perception that is involved in the evaluation of expression and personal traits. In addition SPP showed a significantly weaker activation in the left fusiform gyrus, left dorsolateral prefrontal cortex, and bilateral intraparietal sulcus as compared to HC. These effects were found not only in response to emotional faces but also to neutral faces as compared to scrambled pictures. Thus, SPP showed enhanced activity in brain areas related to processing of information about emotional expression and personality traits. In contrast, brain activity was decreased in areas for attention and for processing other information from the face, perhaps as a result of a feeling of wariness. These results indicate a differential modulation of neural activity throughout the different parts of the distributed neural system for face perception in SPP as compared to HC.

Social phobia in Swedish adolescents

The aim of this study was to investigate the prevalence of self-reported social phobia in a community sample of Swedish adolescents in junior high school, at the risk-period for developing social phobia. Of particular interest was to investigate gender differences in prevalence across ages. Prevalence of sub-threshold social phobia was also studied. Students in grades 6-8 (aged 12-14) from seventeen schools in five Swedish municipalities were screened by means of a self-report questionnaire, the social phobia screening questionnaire-for children (SPSQ-C). Data from a sample of 2,128 students were analysed and showed a point-prevalence rate of 4.4% (95%CI 3.5-5.2) and a significant gender difference (6.6% girls vs. 1.8% boys, P < 0.001). No significant differences in prevalence of probable cases emerged across the ages. At sub-threshold level, marked social fear of at least one social situation was reported by 13.8% of the total group. "Speaking in front of class" and "calling someone unfamiliar on the phone" were the most feared social situations. In the social phobia group, 91.4% reported impairment in the school-domain due to their social fear. Social phobia is a common psychiatric condition in Swedish adolescents, especially in girls. As impairment in the school-domain is reported to a high degree, professionals and teachers need to recognize social phobia in adolescents so that help in overcoming the difficulties can be offered.

Association between level of emotional intelligence and severity of anxiety in generalized social phobia

Generalized social phobia (GSP) is characterized by a marked fear of most social situations. It is associated with an anomalous neural response to emotional stimuli, and individuals with the disorder frequently show interpretation bias in social situations. From this it might be suggested that GSP involves difficulty in accurately perceiving, using, understanding and managing emotions. Here we applied the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT) to medication-free GSP ( n = 28) and no pathology ( n = 21) individuals. Patients with GSP performed within the normal range on the measure however severity of social anxiety significantly correlated with emotional intelligence (EI). Specifically, there was a negative correlation between social anxiety severity and Experiential (basic-level emotional processing) EI. In contrast, there was no significant correlation between social anxiety severity and Strategic (higher-level conscious emotional processing) EI. These results suggest that EI may index emotional processing systems that mitigate the impact of systems causally implicated in GSP.

Escitalopram in specific phobia: results of a placebo-controlled pilot trial

To assess the efficacy and safety of escitalopram in treating specific phobia. The study was performed in an academic medical center. Adults meeting DSM-IV criteria for specific phobia were randomly assigned to 12 weeks of double-blind treatment with escitalopram or placebo. Efficacy measures included the Main Phobia Scale (MPS), the Marks Fear Questionnaire (FQ) and the Clinical Global Impressions of Improvement (CGI-I) scale. Data were collected between September 2002 and September 2004. Of 13 subjects enrolled, 12 returned for at least one post-randomization visit and were included in the intent to treat sample. Response rates on the various subscales of the MPS and the FQ ranged from 20 to 80% for escitalopram, compared to 0-43% with placebo. Rates of response using the CGI-I scale were 60% for escitalopram and 29% for placebo, with a strong between treatment effect in favor of the drug at week 12 (effect-size = 1.13). Using the last observation carried forward, no statistically significant treatment differences were found. The drug was well tolerated. Treatment response was consistently greater for escitalopram than for placebo, with strong effects observed in favor of the drug. However, treatment differences on the primary outcome measures were not significant in this under-powered pilot study. Escitalopram may hold promise as a treatment for specific phobia and larger randomized controlled trials are needed.