The tripartite model of fear in children with specific phobias: Assessing concordance and discordance using the behavioral approach test

doi:10.1016/j.brat.2011.04.003

Behaviour Research and Therapy

Volume 49, Issue 8, August 2011, Pages 459-465

https://doi.org/10.1016/j.brat.2011.04.003 Get rights and content

Abstract

Lang’s tripartite model posits that three main components characterize a fear response: physiological arousal, cognitive (subjective) distress, and behavioral avoidance. These components may occur in tandem with one another (concordance) or they may vary independently (discordance). The behavioral approach test (BAT) has been used to simultaneously examine the three components of the fear response. In the present study, 73 clinic-referred children and adolescents with a specific phobia participated in a phobia-specific BAT. Results revealed an overall pattern of concordance: correlation analyses revealed the three indices were significantly related to one another in the predicted directions. However, considerable variation was noted such that some children were concordant across the response components while others were not. More specifically, based on levels of physiological arousal and subjective distress, two concordant groups (high arousal–high distress, low arousal–low distress) and one discordant (high arousal–low distress or low arousal–high distress) group of youth were identified. These concordant and discordant groups were then compared on the percentage of behavioral steps completed on the BAT. Analyses revealed that the low arousal–low distress group completed a significantly greater percentage of steps than the high arousal–high distress group, and a marginally greater percentage of steps than the discordant group. Potential group differences associated with age, gender, phobia severity, and phobia type were also explored and no significant differences were detected. Implications for theory and treatment are discussed.

Highlights

► Concordance/discordance in clinically phobic children. ► Responses to a behavioral approach test. ► Specific type of phobia related to concordance/discordance. ► Measures of physiology, cognition and behavior.

Section snippets

Participants

Children and adolescents (ages 7–16) from Virginia were recruited for a larger treatment outcome study (Ollendick et al., 2009) through referrals from child mental health services, family medical practices, schools, and newspaper, radio and television advertisements. To be included in the study, participants had to meet criteria for a diagnosis of specific phobia, as defined in the DSM-IV (American Psychiatric Association, 1994). As such, it was required that the phobia receive a clinician

Behavioral approach test and cardiovascular change

A pairwise comparison of IBI demonstrated significant physiological changes from baseline to the BAT (see Table 1). IBI decreased significantly during the BAT, as was expected. An effect size and 95% confidence intervals (CI) were computed for IBI to illustrate the magnitude of the physiological effect during the BAT. Cohen’s d (Cohen, 1988) was computed as: d = (BAT_mean − Baseline_mean)/pooled standard deviation (SD_P). SD_P was computed as: SD_P = [((σ_BAT² + σ_Baseline²)/2)^0.5]. A moderate to large effect

Discussion

On the one hand, our findings are relatively straightforward. First, and importantly, our BATs resulted in heightened physiological arousal (as indexed by decreases in IBI relative to baseline measures). The BATs also resulted in distress and behavioral avoidance in that the average child reported moderate to high levels of distress and was able to complete less than 70% of the behavioral steps. Still, on the three response measures, considerable variability was present. For example, on the

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The tripartite model of fear in children with specific phobias: Assessing concordance and discordance using the behavioral approach test

Abstract

Highlights

Section snippets

Participants

Behavioral approach test and cardiovascular change

Discussion

Personality and Individual Differences

Behaviour Research and Therapy

Behaviour Research & Therapy

Behavior Therapy

Journal of Affective Disorders

Journal of Anxiety Disorders

Journal of Behavior Therapy and Experimental Psychiatry

Behavior Therapy

Behaviour Research and Therapy

Behaviour Research & Therapy

Journal of Dairy Science

Behaviour Research and Therapy

Journal of the American Academy of Child and Adolescent Psychiatry

Behavior Therapy

Diagnostic and statistical manual of mental disorders

Specific phobias

Targeting discrete response channels in the treatment of childhood specific phobia

Clinical Psychology: Science and Practice

The metrics of cardiac chronotropism: biometric perspectives

Psychophysiology

Assessment of anxiety

The anxiety response: concordance among components

Motivation and Emotion

Statistical power analysis for the behavioral sciences

Documenting the efficacy of virtual reality exposure with psychophysiological and information processing measures

Applied Psychophysiology and Biofeedback

Anxiety disorders: Psychological approaches to theory and treatment

Origins of phobias and anxiety disorders