Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders.

Brown, Timothy A.; Nardo, Peter A. Di; Lehman, Cassandra L.; Campbell, Laura A.

doi:10.1037/0021-843x.110.1.49

Cited by 791 publications

(681 citation statements)

References 26 publications

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“…Because data suggest that PTSD is better characterized as a dimensional construct rather than a categorical one (Ruscio, Ruscio, & Keane, 2002), and that evaluation of symptoms on a continuum may yield higher reliabilities and reflect the complete spectrum of a disorder (Brown, Di Nardo, Lehman, & Campbell, 2001), we utilized regression analysis to examine the relationship between negative trauma-related cognitions and a dimensional rating of PTSD symptom severity in a large sample of trauma-exposed college students. The current paper includes data from our first wave of data collection in a longitudinal study aimed at determining the role of trauma-related cognitions in the development of PTSD.…”

Section: Nih Public Accessmentioning

confidence: 99%

Posttraumatic stress disorder symptoms in trauma-exposed college students: The role of trauma-related cognitions, gender, and negative affect

Moser

Hajcak

Simons

et al. 2007

Journal of Anxiety Disorders

111

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Considerable evidence indicates a prominent role for trauma-related cognitions in the development and maintenance of posttraumatic stress disorder (PTSD) symptoms. The present study utilized regression analysis to examine the unique relationships between various trauma-related cognitions and PTSD symptoms after controlling for gender and measures of general affective distress in a large sample of trauma-exposed college students. In terms of trauma-related cognitions, only negative cognitions about the self were related to PTSD symptom severity. Gender and anxiety symptoms were also related to PTSD symptom severity. Theoretical implications of the results are discussed. KeywordsPosttraumatic Stress Disorder; PTSD; Cognitions; Anxiety; Trauma Exposure to traumatic events is quite common, with estimated lifetime rates ranging from 26% to 92.2% in men and from 17.7% to 87.1% in women (Breslau, Davis, Andreski, & Peterson, 1991;Breslau et al., 1999;Creamer, Burgess, & McFarlane, 2001;Kessler et al., 1995;Norris, 1992;Perkonigg, Kessler, Storz, & Wittchen, 2000;Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993;Stein et al., 1997). Although many people experience trauma, only a subset of these individuals subsequently develops posttraumatic stress disorder (PTSD). Lifetime prevalence rates for PTSD range from 1% to 12.3% (Breslau, Davis, Andreski, & Peterson, 1991;Davidson, Hughes, Blazer, & George, 1991;Kessler et al., 1995;Resnick et al., 1993) and current rates of PTSD range from .4% to .9% (Andrews et al., 2001;Perkonigg et al., 2000). PTSD tends to have a chronic course, with as many as 40% continuing to exhibit significant symptoms of the disorder 10 years after its onset (Kessler et al., 1995).Several theories underscore the role that cognitive variables play in the development and maintenance of PTSD (Ehlers & Clark, 2000; Epstien, 1991;Foa & Cahill, 2001;Foa & Jaycox, 1999;Foa & Riggs, 1993;Foa & Rothbaum, 1998;Horowitz, 1986;Janoff-Bulman, 1992;McCann & Pearlman, 1990;Resick & Schnicke, 1992). Utilizing the framework of emotional processing theory (Foa & Kozak, 1986), Foa and colleagues have emphasized the role of cognitions about the self and the world in natural recovery from trauma, the development of Correspondence concerning this article should be addressed to Jason S. Moser, Department of Psychology, University of Delaware, Newark, DE. Email: jmoser@psych.udel.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. PTSD, and the CBT processes that ameliorate PTSD symptoms severity. The theory is rooted in information processing models of memory and psychop...

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Section: Nih Public Accessmentioning

confidence: 99%

Posttraumatic stress disorder symptoms in trauma-exposed college students: The role of trauma-related cognitions, gender, and negative affect

Moser

Hajcak

Simons

et al. 2007

Journal of Anxiety Disorders

111

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“…The kappa coefficient between two independent raters at the center is .77 for social phobia as a principal diagnosis and also .77 for social phobia as a principal or additional diagnosis. The reliability coefficients (kappa) for the other anxiety diagnoses range between .67 (generalized anxiety disorders) and .86 (specific phobias), and between .22 (dysthymia) and .72 (major depressive disorder) for mood disorders (Brown, DiNardo, Lehman, & Campbell, 2001). …”

Section: Assessmentsmentioning

confidence: 99%

Cognitive Mediation of Treatment Change in Social Phobia.

Hofmann¹

2004

Journal of Consulting and Clinical Psychology

261

126

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Ninety individuals with social phobia (social anxiety disorder) participated in a randomized controlled trial and completed cognitive-behavioral group therapy, exposure group therapy without explicit cognitive interventions, or a wait-list control condition. Both treatments were superior to the wait-list group in reducing social anxiety but did not differ from one another at posttest. Changes in estimated social cost mediated treatment changes in both treatment conditions from pre-to posttest. However, only participants who received cognitive-behavioral therapy showed continued improvement from posttest to 6-month follow-up, which was associated with a reduction of estimated social cost from pretest to posttest. These results suggest that cognitive intervention leads to better maintenance of treatment gains, which is mediated through changes in estimated social cost.Social phobia is the most common type of anxiety disorder and the third most common mental disorder in the U.S. population (Kessler et al., 1994). Numerous studies have demonstrated the efficacy of psychological treatments for social phobia, especially cognitive-behavioral therapy and exposure therapy (e.g., Clark et al., 2003;Feske & Chambless, 1995;Heimberg et al., 1998;Taylor, 1996). It has been argued that social phobia treatments involving explicit cognitive strategies should be superior to pure exposure therapy because cognitive interventions are directly aimed at changing dysfunctional thinking (Butler, 1985;Butler, Cullington, Munby, Amies, & Gelder, 1984;Stopa & Clark, 1993). This assumption, however, is not clearly supported by the empirical data. There are eight controlled clinical studies in the literature in which investigators directly compared cognitive-behavioral therapy with exposure therapy without explicit cognitive interventions (Butler et al., 1984;Emmelkamp, Mersch, Vissia, & van der Helm, 1985;Gelernter et al., 1991;Hope, Heimberg, & Bruch, 1995;Mattick & Peters, 1988;Mattick, Peters, & Clark, 1989;Scholing & Emmelkamp, 1993a, 1993b. In only two of the trials did the effects of cognitive-behavioral therapy exceed those of exposure alone at posttreatment (Butler et al., 1984;Mattick & Peters, 1988). Furthermore, a number of meta-analyses suggested that both cognitive-behavioral therapy and exposure therapy produce very similar dropouts and pre/post and pre/follow-up effects for self-report measures of social phobia, cognitive symptoms, and depressed-anxious mood (Feske & Chambless, 1995;Gould, Buckminster, Pollack, Otto, & Yap, 1997;Taylor, 1996). Finally, the results of a dismantling study conducted by Hope, Heimberg, and Bruch (1995) suggest that exposure alone is at least as effective as exposure plus cognitive intervention in the treatment of social phobia.These findings raise important questions about the mechanism of treatment changes and the variables that are involved in this change process (i.e., the mediators of change). The cognitive model of social phobia posits that certain beliefs about the social situation...

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“…The reliability coefficients (kappa) for the other anxiety diagnoses ranged between .67 (generalized anxiety disorders) and .86 (specific phobias) and between .22 (dysthymia) and . 72 (major depressive disorder) for mood disorders (Brown et al, 2001). …”

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confidence: 99%

Sudden gains during therapy of social phobia.

Hofmann

Schulz

Meuret

et al. 2006

Journal of Consulting and Clinical Psychology

105

109

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The present study investigated the phenomenon of sudden gains in 107 participants with social phobia (social anxiety disorder) who received either cognitive-behavioral group therapy or exposure group therapy without explicit cognitive interventions, which primarily used public speaking situations as exposure tasks. Twenty-two out of 967 session-to-session intervals met criteria for sudden gains, which most frequently occurred in Session 5. Individuals with sudden gains showed similar improvements in the 2 treatment groups. Although cognitive-behavioral therapy was associated with more cognitive changes than exposure therapy, cognitive changes did not precede sudden gains. In general, the results of this study question the clinical significance of sudden gains in social phobia treatment.Keywords sudden gains; social anxiety disorder; social phobia; cognitive-behavioral therapy; exposure therapyIn recent years, psychotherapy researchers have investigated the phenomenon of large, rapid, and stable decreases in symptomatology during treatment, which has been referred to as sudden gains (Tang & DeRubeis, 1999b). Sudden gains are typically defined by a set of three quantitative criteria: (a) the sudden gain must be large in absolute terms, (b) the sudden gain must represent at least a 25% reduction from the level of symptomatology before the gain occurred, and (c) the mean level of symptomatology in the three therapy sessions preceding the gain must be significantly higher than the mean level of symptomatology in the three postgain sessions. Most studies of sudden gains have examined treatment changes in depression with the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961; but see also Stiles et al., 2003;Vittengl, Clark, & Jarrett, 2005).When applying these criteria, Tang and DeRubeis (1999b) found that sudden gains occurred in more than 50% of individuals who responded to cognitive-behavioral therapy for depression and that these gains accounted for more than 50% of these individuals' total improvement in depression. Compared with participants who did not experience sudden gains at posttreatment, individuals with sudden gains showed better outcome at posttreatment and at 6-month and 18-month follow-ups.The initial study by Tang and DeRubeis (1999b) was followed by a number of other studies examining sudden gains (Gaynor et al., 2003;Hardy et al., 2005;Kelly, Roberts, & Ciesla, 2005;Tang, DeRubeis, Beberman, & Pham, 2005;Tang, Luborsky, & Andrusyna, 2002;Vittengl, Clark, & Jarrett, 2005). Interventions in these studies ranged from traditional cognitive therapy to supportive expressive therapy or pharmacotherapy. Although sudden gains were primarily assessed in efficacy trials of time-limited individual treatments (e.g., Tang NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript DeRubeis, 1999b;Vittengl et al., 2005), their incidence was also assessed in group therapy for depression (Kelly et al., 2005) and individuals with mixed psychiatric diagnoses who were g...

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Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders.

Cited by 791 publications

References 26 publications

Posttraumatic stress disorder symptoms in trauma-exposed college students: The role of trauma-related cognitions, gender, and negative affect

Posttraumatic stress disorder symptoms in trauma-exposed college students: The role of trauma-related cognitions, gender, and negative affect

Cognitive Mediation of Treatment Change in Social Phobia.

Sudden gains during therapy of social phobia.

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