This study examined factors influencing parent willingness to use D-Cycloserine (DCS) for treating child anxiety. N = 222 parents were given information about using DCS to treat anxiety. They were then asked to rate their willingness to allow their child to take DCS/antibiotics for mild anxiety, severe anxiety, or an infection. The associations between willingness to use DCS and parental trait anxiety, demographics, as well as specific concerns regarding the medication, were examined. Parents could also provide written responses regarding their attitudes to DCS, which were analysed for themes. Parents reported concerns regarding potential side-effects from DCS. More severe anxiety was associated with more willingness to consent; however, parents were more willing to use antibiotics to treat an infection than DCS to treat their child's anxiety. The degree of perceived benefit from DCS was most strongly associated with parents’ willingness to use it. Overall, parents expressed mixed views, reporting they would consider using DCS to treat their child; however, they had significant concerns about it. Results suggest providing parents with information explaining how DCS works, its risks and potential benefits may increase its acceptability.

Background: People with anxiety disorders occasionally report fears about losing control of basic bodily functions in public. These anxieties often occur in the absence of physical disorder and have previously been recognized as “obsessive” anxieties reflecting a preoccupation with loss of bowel/bladder control. Motivated by our observations of the non-trivial occurrence of such anxieties in our clinical practice we sought to fill a gap in the current understanding of “bowel/bladder-control anxieties”. Method: Eligible participants completed an internet survey. Results: Bowel/bladder-control anxieties (n = 140) tended to emerge in the mid to late 20s and were associated with high levels of avoidance and functional impairment. There was a high prevalence of panic attacks (78%); these were especially prevalent among those with bowel-control anxiety. Of those with panic attacks, 62% indicated that their main concern was being incontinent during a panic attack. Significantly, a proportion of respondents (~16%) reported actually being incontinent during a panic attack. Seventy percent of participants reported intrusive imagery related to loss of bowel/bladder control. Intrusion-related distress was correlated with agoraphobic avoidance and general role impairment. Some differences were noted between those with predominantly bowel-, predominantly bladder- and those with both bowel and bladder-control anxieties. Conclusion: This preliminary characterization indicates that even in a non-treatment seeking community sample, bowel/bladder-control anxieties are associated with high levels of distress and impairment. Further careful characterization of these anxieties will clarify their phenomenology and help us develop or modify treatment protocols in a way that takes account of any special characteristics of such viscerally-centred phobic syndromes.

A 35-year-old Middle Eastern woman, experiencing moderate depression compounded by animal phobia was referred to an Improving Access to Psychological Therapies (IAPT) service. Shared understandings were gradually developed using written functional analyses translated in session. Activity scheduling was integrated with graded exposure to increase access to positive reinforcement. Questionnaires and subjective data indicated a reduction in phobic avoidance and functioning increased. Despite the complexity of working as a triad, a positive therapeutic relationship was achieved with increased mutual cultural understanding. Indirect communication led to difficulties maintaining guided discovery and focus. There is limited evidence to support CBT when delivered through an interpreter. IAPT recommendations suggest staff reflect the community; the North East has one of the lowest foreign-born populations in the UK indicating that IAPT services may be ill prepared to work with ethnic minorities. Learning points for the therapist were: maintain simplicity, take time to formulate incorporation of cultural difference, and use transcultural interventions. The interpreter brought advantages; providing means of communication and understanding of cultural differences. Disadvantages were the potential for bias or lost information, increased time and complexity of delivering therapy. This case indicates a deficit in high intensity training and lack of literature to support therapists.

Background: Distressing visual hallucinations (VH) are frequently present in schizophrenia. Despite their prevalence, limited research exists regarding effective clinical interventions. Cognitive models of VH state that distress results from threat appraisals of the hallucination. Method: This individual case study describes the use of a graded exposure approach following the discovery of phobic anxiety associated with visual hallucinatory content. Treatment involved 20 sessions of individual cognitive behaviour therapy (CBT), of which 12 sessions focused on graded exposure. Results: A reduction in frequency of visions and associated distress was reported and these changes were maintained at a 3-month follow-up. Conclusions: The findings are consistent with the cognitive model of VH. Through exposure to the hallucinatory content, the client re-appraised her VH as non-threatening, and her fear of them reduced. This reduction in anxiety led to a decrease in the occurrence of the VH.

Evaluations of computer-guided CBT (CCBT) suggest that this is a promising approach to closing the gap between the demand for, and the supply of, CBT. However, additional studies are required that are conducted by researchers independent of the programme developers, and include a wider range of participants. This independent study examined the viability of CCBT for panic and phobic anxiety in an unselected sample of referrals in remote and rural areas of Scotland. Outcome was assessed by a wide range of outcome measures, completed before and after treatment, and at 4-month follow-up. Participants experienced few difficulties in using the programme, and GPs and participants regarded CCBT as acceptable and useful. Major improvements were obtained, with several large effect sizes, which remained at follow-up. It was concluded that computer-guided CBT can play a useful part in delivering CBT services in rural areas; and that self-help CBT may be the only treatment option available to some sufferers.

The present study was designed to test the hypothesis that blood fearful and nonfearful individuals would be differentiated by their pattern of recall of schematic and non-schematic prose material. Blood fearful (n=36) and nonfearful (n=40) individuals were presented with five prose passages describing harm or injury. Nine sentences in each passage described events representative of the schema content of most individuals, whereas six sentences in each passage described events that are not representative of typical schema content. Participants read passages that either described themselves experiencing the situations or described themselves witnessing others in the situations and completed a free recall task in both immediate (i.e. 2 minutes) and delayed (i.e. one week) recall conditions. Results did not replicate studies from the cognitive psychology literature on which this study was based. Instead, participants who read passages describing themselves in these situations recalled the gist of the material more accurately than participants who read passages in which they witnessed another individual in the situation. Blood fearful participants recalled the affective tone of neutral passages less accurately than nonfearful participants. Results suggest that activation of schema content has little influence on memory performance, although assessing the affective tone of recalled material detected subtle differences in memory performance between fearful and nonfearful groups.

A. Öhman and J.J.F. Soares (1994) demonstrated that masked presentation of phobic pictures produces increased skin conductance responses (SCRs) in phobic subjects. A. Öhman (1993) explained this phenomenon in terms of a hypothetical “feature detector” that identifies physical characteristics of stimuli and activates the arousal system without involving significance evaluation or consciousness. By exposing spider phobics to spider words, general threat words, and neutral words instead of pictures, this explanation was tested. Words were presented both masked and unmasked while electrodermal activity was measured. Under unmasked conditions, SCRs were largest for spider words followed by general threat words, then neutral words. When masked, the difference between spider words and general threat words disappeared but SCRs remained significantly smaller for neutral words. It is concluded that activation of the arousal system by masked threat cues does not necessarily depend on their perceptual characteristics.

The discriminant validity of children's and parents' ratings of the child's fear on the Revised Fear Survey Schedule for Children (FSSC-R; Ollendick, 1983) was examined using a clinic sample of children who met DSM criteria for phobic disorders (N=120). Discriminant function analyses and item analyses were conducted to determine if children meeting diagnostic criteria for a primary disorder of social phobia, simple phobia of the dark/sleeping alone, simple phobia of animals, or a simple phobia of shots/doctors could be differentiated on the basis of FSSC-R subscale scores and items. Results of the discriminant function analyses indicated that the child-completed as well as the parent-completed FSSC-Rs were similarly useful in differentiating the specific types of phobias. Results of the item analyses indicated that child-completed FSSC-R items could discriminate among the different simple phobias but not social phobia and that parent-completed FSSC-R items could discriminate not only the different simple phobias but also social phobia. Results are discussed in terms of the utility of the FSSC-R in the assessment of clinically significant fears in children with phobic disorders and the relative utility of child and parent ratings in the assessment of childhood fears.

The temporal course of startle reflex modulation and autonomic response patterns to fear-relevant and fear-irrelevant pictures in subjects with high and low levels of animal fear was investigated. Thirty-eight high-fear and 48 low-fear volunteers viewed photos of snakes and spiders and pictures of neutral and pleasant content. The slides were presented for 6 s or for only 150 ms, depending on the group. Acoustic startle probes were presented at five different times after slide onset. Relative potentiation of the startle responses started 300 ms after onset of snake/spider pictures in fearful subjects. This fear-potentiated startle effect was maintained for the later probe times and was identical in the 150-ms condition. Fear-relevant pictures also prompted a sympathetically dominated autonomic response profile in fearful persons. These data support the idea that fear can be activated very rapidly, requiring only minimal stimulus input.

Doll phobia is a rare phobia that has only been reported twice in the literature, both times in male patients. The following case is the first to be described in a female patient. The characteristics of the dolls that caused most fear in all three cases are compared and the possibility that this indicates a similar genesis of the phobia that could be explored by psychodynamic psychotherapy is discussed. A Hellenic derivation of doll phobia for future use is suggested.

Cette étude rétrospective a été entreprise chez 35 patients ambulatoires répondant aux diagnostics DSM III de troubles panique ou d’agoraphobie avec attaques de panique (AP), dans le but de mettre en évidence la chronologie d’apparition de différents symptômes d’anxiété chez ce type de patients. Dans plus de 90% des cas, la survenue d’AP précède ou inaugure l'apparition des symptômes permettant de porter les diagnostics mentionnés précédemment; comme cela est rapporté dans la littérature, ces AP paraissent survenir le plus souvent au décours d’une période de difficultés personnelles de natures diverses considérées comme «stressantes» par les patients con-cernés. D'autre part, chez 30% des patients répondant au diagnostic d’agoraphobie avec AP, on relève l'existence d’antécédents phobiques préexistant à l'apparition des premières crises d’angoisse-panique; l'existence de tels antécédents n'est relevée que chez 8% des patients répondant au diagnostic de troubles panique. L'hypothèse selon laquelle une prédisposition phobique favoriserait le développement de l'agoraphobie chez des patients présentant des AP répétées mériterait d’être confirmée par des enquêtes rétrospectives plus systématiques sur des échantillons cliniques plus larges.