Childhood separation anxiety and the pathogenesis and treatment of adult anxiety

American Journal of Psychiatry

Volumn 171, Issue 1, 2014, Pages 34-43

  Milrod, Barbara ^a,b,c   Markowitz, John C ^a,b,c   Gerber, Andrew J ^a,b,c   Cyranowski, Jill ^a,b,c   Altemus, Margaret ^a,b,c   Shapiro, Theodore ^a,b,c   Hofer, Myron ^a,b,c   Glatt, Charles ^a,b,c  

^a WEILL CORNELL MEDICAL COLLEGE   (United States)

^b NEW YORK STATE PSYCHIATRIC INSTITUTE   (United States)

^c UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

BIOLOGICAL MARKER; OXYTOCIN; OXYTOCIN RECEPTOR; SEROTONIN UPTAKE INHIBITOR;

ADULT; AGORAPHOBIA; ANXIETY DISORDER; CHILD; CHILD PARENT RELATION; CHILDHOOD; DISEASE MARKER; EMOTIONALITY; EPIGENETICS; GENETIC ANALYSIS; GENETIC MODEL; HUMAN; MOOD DISORDER; NEUROIMAGING; NONHUMAN; PANIC; PATHOGENESIS; PREVALENCE; PRIORITY JOURNAL; PROTEIN POLYMORPHISM; PSYCHOSOCIAL CARE; QUALITY OF LIFE; REVIEW; SEPARATION ANXIETY; SOCIAL SUPPORT; TREATMENT OUTCOME;

ADULT; ANIMALS; ANXIETY DISORDERS; ANXIETY, SEPARATION; CHILD; DISEASE MODELS, ANIMAL; HUMANS; MODELS, PSYCHOLOGICAL; OBJECT ATTACHMENT; SOCIAL SUPPORT;

EID: 84891689886     PISSN: 0002953X     EISSN: 15357228     Source Type: Journal    
DOI: 10.1176/appi.ajp.2013.13060781     Document Type: Review

References (98)

1. Simpson HB: The RDoC project: a new paradigm for investigating the pathophysiology of anxiety. Depress Anxiety 2012;29:251-252
2. Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, Sanislow C, Wang P: Research Domain Criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry 2010;167:748-751
3. Freud S: Analysis of a phobia in a five-year-old boy (1909), in Complete Psychological Works, standarded, vol 10. London, Hogarth Press, 1955
4. Bowlby J: A Secure Base: Parent-Child Attachment and Healthy Human Development. London, Routledge, 1988
5. Bowlby J: Attachment and Loss. New York, Basic Books, 1973
6. Manicavasagar V, Silove D, Curtis J: Separation anxiety in adulthood: a phenomenological investigation. Compr Psychiatry 1997;38:274-282 (Pubitemid 27391591)
7. Busch FN, Milrod BL, Singer MB, Aronson AC: Manual of Panic Focused Psychodynamic Psychotherapy: eXtended Range. New York, Routledge, 2011
8. Shear MK: Factors in the etiology and pathogenesis of panic disorder: revisiting the attachment-separation paradigm. Am J Psychiatry 1996;153(July suppl):125-136 (Pubitemid 26235225)
9. Gittelman R, Klein DF: Relationship between separation anxiety and panic and agoraphobic disorders. Psychopathology 1984;17(suppl 1):56-65 (Pubitemid 14131323)
10. Kossowsky J, Pfaltz MC, Schneider S, Taeymans J, Locher C, Gaab J: The separation anxiety hypothesis of panic disorder revisited: a meta-analysis. Am J Psychiatry 2013;170:768-781
11. Lewinsohn PM, Holm-Denoma JM, Small JW, Seeley JR, Joiner TE: Separation anxiety disorder in childhood as a risk factor for future mental illness. J Am Acad Child Adolesc Psychiatry 2008;47:548-555 (Pubitemid 351591604)
12. Oler JA, Fox AS, Shelton SE, Rogers J, Dyer TD, Davidson RJ, Shelledy W, Oakes TR, Blangero J, Kalin NH: Amygdalar and hippocampal substrates of anxious temperament differ in their heritability. Nature 2010;466:864-868
13. Paquette V, Lévesque J, Mensour B, Leroux JM, Beaudoin G, Bourgouin P, Beauregard M: "Change the mind and you change the brain": effects of cognitive-behavioral therapy on the neural correlates of spider phobia. Neuroimage 2003;18:401-409 (Pubitemid 36269149)
14. DiNardo PA, Brown TA, Barlow DH: Anxiety Disorders Interview Schedule for DSM-IV: Lifetime Version (ADIS-IV-L). New York, Graywinds Publications, 1995
15. American Psychiatric Association: Diagnostic and Statistical Manual for Mental Disorders, 4th ed (DSM-IV). Washington, DC, APA, 1994
16. Shear K, Jin R, Ruscio AM, Walters EE, Kessler RC: Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication. Am J Psychiatry 2006;163:1074-1083 (Pubitemid 44464495)
17. Silove DM, Marnane CL, Wagner R, Manicavasagar VL, Rees S: The prevalence and correlates of adult separation anxiety disorder in an anxiety clinic. BMC Psychiatry 2010;10:21
18. Pini S, Abelli M, Shear KM, Cardini A, Lari L, Gesi C, Muti M, Calugi S, Galderisi S, Troisi A, Bertolino A, Cassano GB: Frequency and clinical correlates of adult separation anxiety in a sample of 508 outpatients with mood and anxiety disorders. Acta Psychiatr Scand 2010;122:40-46
19. Ainsworth M, Blehar M, Waters E, Wall S: Patterns of Attachment. Hillsdale, NJ, Erlbaum, 1978
20. Manicavasagar V, Marnane C, Pini S, Abelli M, Rees S, Eapen V, Silove D: Adult separation anxiety disorder: a disorder comes of age. Curr Psychiatry Rep 2010;12:290-297
21. Roberson-Nay R, Eaves LJ, Hettema JM, Kendler KS, Silberg JL: Childhood separation anxiety disorder and adult onset panic attacks share a common genetic diathesis. Depress Anxiety 2012;29:320-327
22. Vrticka P, Vuilleumier P: Neuroscience of human social interactions and adult attachment style. Front Hum Neurosci 2012;6:212
23. Soliman F, Glatt CE, Bath KG, Levita L, Jones RM, Pattwell SS, Jing D, Tottenham N, Amso D, Somerville LH, Voss HU, Glover G, Ballon DJ, Liston C, Teslovich T, Van Kempen T, Lee FS, Casey BJ: A genetic variant BDNF polymorphism alters extinction learning in both mouse and human. Science 2010;327:863-866
24. Hartley CA, McKenna MC, Salman R, Holmes A, Casey BJ, Phelps EA, Glatt CE: Serotonin transporter polyadenylation polymorphism modulates the retention of fear extinction memory. Proc Natl Acad Sci USA 2012;109:5493-5498
25. Costa B, Pini S, Gabelloni P, Abelli M, Lari L, Cardini A, Muti M, Gesi C, Landi S, Galderisi S, Mucci A, Lucacchini A, Cassano GB, Martini C: Oxytocin receptor polymorphisms and adult attachment style in patients with depression. Psychoneuroendocrinology 2009;34:1506-1514
26. Walum H, Westberg L, Henningsson S, Neiderhiser JM, Reiss D, Igl W, Ganiban JM, Spotts EL, Pedersen NL, Eriksson E, Lichtenstein P: Genetic variation in the vasopressin receptor 1a gene (AVPR1A) associates with pair-bonding behavior in humans. Proc Natl Acad Sci USA 2008;105:14153-14156
27. Gillath O, Shaver PR, Baek JM, Chun DS: Genetic correlates of adult attachment style. Pers Soc Psychol Bull 2008;34:1396-1405
28. Brunelli SA, Hofer MA: Selective breeding for infant rat separation-induced ultrasonic vocalizations: developmental precursors of passive and active coping styles. Behav Brain Res 2007;182:193-207 (Pubitemid 47101913)
29. Hofer MA: Multiple regulators of ultrasonic vocalization in the infant rat. Psychoneuroendocrinology 1996;21:203-217 (Pubitemid 26198206)
30. Coplan JD, Mathew SJ, Abdallah CG, Mao X, Kral JG, Smith EL, Rosenblum LA, Perera TD, Dwork AJ, Hof PR, Gorman JM, Shungu DC: Early-life stress and neurometabolites of the hippocampus. Brain Res 2010;1358:191-199
31. Jackowski A, Perera TD, Abdallah CG, Garrido G, Tang CY, Martinez J, Mathew SJ, Gorman JM, Rosenblum LA, Smith EL, Dwork AJ, Shungu DC, Kaffman A, Gelernter J, Coplan JD, Kaufman J: Early-life stress, corpus callosum development, hippocampal volumetrics, and anxious behavior in male nonhuman primates. Psychiatry Res 2011;192:37-44
32. Coplan JD, Abdallah CG, Kaufman J, Gelernter J, Smith EL, Perera TD, Dwork AJ, Kaffman A, Gorman JM, Rosenblum LA, Owens MJ, Nemeroff CB: Early-life stress, corticotropin-releasing factor, and serotonin transporter gene: a pilot study. Psychoneuroendocrinology 2011;36:289-293
33. Diorio J, Meaney MJ: Maternal programming of defensive responses through sustained effects on gene expression. J Psychiatry Neurosci 2007;32:275-284 (Pubitemid 47057461)
34. Champagne FA, Weaver IC, Diorio J, Dymov S, Szyf M, Meaney MJ: Maternal care associated with methylation of the estrogen receptor-alpha1b promoter and estrogen receptor-alpha expression in the medial preoptic area of female offspring. Endocrinology 2006;147:2909-2915 (Pubitemid 43764626)
35. Cassano GB, Michelini S, Shear MK, Coli E, Maser JD, Frank E: The panic-agoraphobic spectrum: a descriptive approach to the assessment and treatment of subtle symptoms. Am J Psychiatry 1997;154(June suppl):27-38 (Pubitemid 27225244)
36. Vanderwerker LC, Jacobs SC, Parkes CM, Prigerson HG: An exploration of associations between separation anxiety in childhood and complicated grief in later life. J Nerv Ment Dis 2006;194:121-123 (Pubitemid 43260191)
37. Cassano GB, Dell'Osso L, Frank E, Miniati M, Fagiolini A, Shear K, Pini S, Maser J: The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology. J Affect Disord 1999;54:319-328 (Pubitemid 29329443)
38. Dell'osso L, Carmassi C, Corsi M, Pergentini I, Socci C, Maremmani AG, Perugi G: Adult separation anxiety in patients with complicated grief versus healthy control subjects: relationships with lifetime depressive and hypomanic symptoms. Ann Gen Psychiatry 2011;10:29
39. Feske U, Frank E, Mallinger AG, Houck PR, Fagiolini A, Shear MK, Grochocinski VJ, Kupfer DJ: Anxiety as a correlate of response to the acute treatment of bipolar I disorder. Am J Psychiatry 2000;157:956-962 (Pubitemid 30412347)
40. Frank E, Cyranowski JM, Rucci P, Shear MK, Fagiolini A, Thase ME, Cassano GB, Grochocinski VJ, Kostelnik B, Kupfer DJ: Clinical significance of lifetime panic spectrum symptoms in the treatment of patients with bipolar I disorder. Arch Gen Psychiatry 2002;59:905-911
41. Fagiolini A, Frank E, Rucci P, Cassano GB, Turkin S, Kupfer DJ: Mood and anxiety spectrum as a means to identify clinically relevant subtypes of bipolar I disorder. Bipolar Disord 2007;9:462-467 (Pubitemid 47202508)
42. Perugi G, Akiskal HS: The soft bipolar spectrum redefined: focus on the cyclothymic, anxious-sensitive, impulse-dyscontrol, and binge-eating connection in bipolar II and related conditions. Psychiatr Clin North Am 2002;25:713-737 (Pubitemid 35351203)
43. Toni C, Perugi G, Frare F, Tusini G, Fountoulakis KN, Akiskal KK, Akiskal HS: The clinical-familial correlates and naturalistic outcome of panic-disorder-agoraphobia with and without lifetime bipolar II comorbidity. Ann Gen Psychiatry 2008;7:23
44. Perugi G, Toni C, Maremmani I, Tusini G, Ramacciotti S, Madia A, Fornaro M, Akiskal HS: The influence of affective temperaments and psychopathological traits on the definition of bipolar disorder subtypes: a study on bipolar I Italian national sample. J Affect Disord 2012;136:e41-e49
45. Silove D, Marnane C, Wagner R, Manicavasagar V: Brief report-associations of personality disorder with early separation anxiety in patients with adult separation anxiety disorder. J Pers Disord 2011;25:128-133
46. Benvenuti A, Rucci P, Calugi S, Cassano GB, Miniati M, Frank E: Relationship of residual mood and panic-agoraphobic spectrum phenomenology to quality of life and functional impairment in patients with major depression. Int Clin Psychopharmacol 2010;25:68-74
47. Frank E, Shear MK, Rucci P, Cyranowski JM, Endicott J, Fagiolini A, Grochocinski VJ, Houck P, Kupfer DJ, Maser JD, Cassano GB: Influence of panic-agoraphobic spectrum symptoms on treatment response in patients with recurrent major depression. Am J Psychiatry 2000;157:1101-1107 (Pubitemid 30432491)
48. Miniati M, Calugi S, Rucci P, Shear MK, Benvenuti A, Santoro D, Mauri M, Cassano GB: Predictors of response among patients with panic disorder treated with medications in a naturalistic follow-up: the role of adult separation anxiety. J Affect Disord 2012;136:675-679
49. Coryell W, Fiedorowicz JG, Solomon D, Leon AC, Rice JP, Keller MB: Effects of anxiety on the long-term course of depressive disorders. Br J Psychiatry 2012;200:210-215
50. Weissman MM, Markowitz JC, Klerman GL: Clinicians' Quick Guide to Interpersonal Psychotherapy. New York, Oxford University Press, 2007
51. Aaronson CJ, Shear MK, Goetz RR, Allen LB, Barlow DH, White KS, Ray S, Money R, Saksa JR, Woods SW, Gorman JM: Predictors and time course of response among panic disorder patients treated with cognitive-behavioral therapy. J Clin Psychiatry 2008;69:418-424 (Pubitemid 351549395)
52. Last CG, Hersen M, Kazdin A, Orvaschel H, Perrin S: Anxiety disorders in children and their families. Arch Gen Psychiatry 1991;48:928-934
53. Rapee RM, Kennedy SJ, Ingram M, Edwards SL, Sweeney L: Altering the trajectory of anxiety in at-risk young children. Am J Psychiatry 2010;167:1518-1525
54. Warren SL, Huston L, Egeland B, Sroufe LA: Child and adolescent anxiety disorders and early attachment. J Am Acad Child Adol Psychiatry 1997;36:637-644 (Pubitemid 27184071)
55. Hudson JL, Rapee RM: Parent-child interactions in clinically anxious children and their siblings. J Clin Child Adolesc Psychol 2002;31:548-555 (Pubitemid 37110239)
56. Rosenbaum JF, Biederman J, Gersten M, Hirshfeld DR, Meminger SR, Herman JB, Kagan J, Reznick JS, Snidman N: Behavioral inhibition in children of parents with panic disorder and agoraphobia: a controlled study. Arch Gen Psychiatry 1988;45:463-470
57. Last CG, Hersen M, Kazdin AE, Francis G, Grubb HJ: Psychiatric illness in the mothers of anxious children. Am J Psychiatry 1987;144:1580-1583 (Pubitemid 18005555)
58. Herren C, In-Albon T, Schneider S: Beliefs regarding child anxiety and parenting competence in parents of children with separation anxiety disorder. J Behav Ther Exp Psychiatry 2013;44:53-60
59. Milrod B, Bush F, Shapiro T: Psychodynamic Approaches to the Adolescent with Panic Disorder. Malabar, Fla, Krieger, 2004
60. Benoit D, Parker KC: Stability and transmission of attachment across three generations. Child Dev 1994;65:1444-1456
61. Mahler MS, Pine F, Bergman A: The Psychological Birth of the Human Infant Symbiosis and Individuation. New York, Basic Books, 1975
62. Groh AM, Roisman GI, van Ijzendoorn MH, Bakermans-Kranenburg MJ, Fearon RP: The significance of insecure and disorganized attachment for children's internalizing symptoms: a meta-analytic study. Child Dev 2012;83:591-610
63. Fonagy P, Steele M, Steele H, Leigh T, Kennedy R, Mattoon G, Target M: Attachment, the reflective self, and borderline states: the predictive specificity of the Adult Attachment Interview and pathological emotional development, in Attachment Theory: Social, Developmental, and Clinical Perspectives. Edited by Goldberg S, Muir R, Kerr J. Hillsdale, NJ, Analytic Press, 1995, pp 233-278
64. Baram TZ, Davis EP, Obenaus A, Sandman CA, Small SL: Fragmentation and unpredictability of early-life experience in mental disorders. Am J Psychiatry 2012;169:907-915
65. Fonagy P: The human genome and the representational world: the role of early mother-infant interaction in creating an interpersonal interpretive mechanism. Bull Menninger Clin 2001;65:427-448 (Pubitemid 32778063)
66. Laor N, Wolmer L, Mayes LC, Golomb A, Silverberg DS, Weizman R, Cohen DJ: Israeli preschoolers under Scud missile attacks: a developmental perspective on risk-modifying factors. Arch Gen Psychiatry 1996;53:416-423 (Pubitemid 26149230)
67. Markowitz JC, Milrod B, Bleiberg KL, Marshall RD: Interpersonal factors in understanding and treating posttraumatic stress disorder. J Psychiatr Pract 2009;15:133-140
68. Saxe GN, Stoddard F, Hall E, Chawla N, Lopez C, Sheridan R, King D, King L, Yehuda R: Pathways to PTSD, part I: children with burns. Am J Psychiatry 2005;162:1299-1304 (Pubitemid 40905580)
69. Markowitz JC, Milrod BL: The importance of responding to negative affect in psychotherapies. Am J Psychiatry 2011;168:124-128
70. Stefini A, Horn H, Winkelmann K, Geiser-Elze A, Hartmann M, Kronmrüller KT: Attachment styles and outcome of psychoanalytic psychotherapy for children and adolescents. Psychopathology 2013;46:192-200
71. Levy KN, Ellison WD, Scott LN, Bernecker SL: Attachment style. J Clin Psychol 2011;67:193-203
72. Torres B, Alonso-Arbiol I, Cantero MJ, Abubakar A: Infant-mother attachment can be improved through group intervention: a preliminary evaluation in Spain in a non-randomized controlled trial. Span J Psychol 2011;14:630-638
73. Ramsauer B, Gehrke J, Lotzin A, Powell B, Romer G: [Attachment and attachment-based intervention: the Circle of Security intervention project in Hamburg]. Prax Kinderpsychol Kinderpsychiatr 2011;60:417-429
74. Levy KN, Meehan KB, Kelly KM, Reynoso JS, Weber M, Clarkin JF, Kernberg OF: Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. J Consult Clin Psychol 2006;74:1027-1040 (Pubitemid 44950827)
75. Rudden M, Milrod B, Target M, Ackerman S, Graf E: Reflective functioning in panic disorder patients: a pilot study. J Am Psychoanal Assoc 2006;54:1339-1343
76. Fonagy P, Leigh T, Steele M, Steele H, Kennedy R, Mattoon G, Target M, Gerber A: The relation of attachment status, psychiatric classification, and response to psychotherapy. J Consult Clin Psychol 1996;64:22-31 (Pubitemid 26076062)
77. Cyranowski JM, Frank E, Shear MK, Swartz H, Fagiolini A, Scott J, Kupfer DJ: Interpersonal psychotherapy for depression with panic spectrum symptoms: a pilot study. Depress Anxiety 2005;21:140-142 (Pubitemid 41040637)
78. Milrod B, Leon AC, Busch F, Rudden M, Schwalberg M, Clarkin J, Aronson A, Singer M, Turchin W, Klass ET, Graf E, Teres JJ, Shear MK: A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. Am J Psychiatry 2007;164:265-272
79. Siev J, Chambless DL: Specificity of treatment effects: cognitive therapy and relaxation for generalized anxiety and panic disorders. J Consult Clin Psychol 2007;75:513-522 (Pubitemid 47444755)
80. Bornstein MH, Suess PE: Child and mother cardiac vagal tone: continuity, stability, and concordance across the first 5 years. Dev Psychol 2000;36:54-65
81. Sack M, Hopper JW, Lamprecht F: Low respiratory sinus arrhythmia and prolonged psychophysiological arousal in posttraumatic stress disorder: heart rate dynamics and individual differences in arousal regulation. Biol Psychiatry 2004;55:284-290 (Pubitemid 38117165)
82. Friedman BH: An autonomic flexibility-neurovisceral integration model of anxiety and cardiac vagal tone. Biol Psychol 2007;74:185-199 (Pubitemid 46001790)
83. Rottenberg J: Cardiac vagal control in depression: a critical analysis. Biol Psychol 2007;74:200-211 (Pubitemid 44969448)
84. Weinberg A, Klonsky ED, Hajcak G: Autonomic impairment in borderline personality disorder: a laboratory investigation. Brain Cogn 2009;71:279-286
85. Fabes RA, Eisenberg N: Regulatory control and adults' stressrelated responses to daily life events. J Pers Soc Psychol 1997;73:1107-1117 (Pubitemid 127688904)
86. Friedman BH, Thayer JF: Autonomic balance revisited: panic anxiety and heart rate variability. J Psychosom Res 1998;44:133-151 (Pubitemid 28029896)
87. Insel TR: The challenge of translation in social neuroscience: a review of oxytocin, vasopressin, and affiliative behavior. Neuron 2010;65:768-779
88. Bartz JA, Zaki J, Ochsner KN, Bolger N, Kolevzon A, Ludwig N, Lydon JE: Effects of oxytocin on recollections of maternal care and closeness. Proc Natl Acad Sci USA 2010;107:21371-21375
89. Bartz J, Simeon D, Hamilton H, Kim S, Crystal S, Braun A, Vicens V, Hollander E: Oxytocin can hinder trust and cooperation in borderline personality disorder. Soc Cogn Affect Neurosci 2011;6:556-563
90. Bartz JA, Zaki J, Bolger N, Hollander E, Ludwig NN, Kolevzon A, Ochsner KN: Oxytocin selectively improves empathic accuracy. Psychol Sci 2010;21:1426-1428
91. Feldman R, Weller A, Zagoory-Sharon O, Levine A: Evidence for a neuroendocrinological foundation of human affiliation: plasma oxytocin levels across pregnancy and the postpartum period predict mother-infant bonding. Psychol Sci 2007;18:965-970
92. Gordon I, Zagoory-Sharon O, Leckman JF, Feldman R: Prolactin, oxytocin, and the development of paternal behavior across the first six months of fatherhood. Horm Behav 2010;58:513-518
93. Marazziti D, Dell'Osso B, Baroni S, Mungai F, Catena M, Rucci P, Albanese F, Giannaccini G, Betti L, Fabbrini L, Italiani P, Del Debbio A, Lucacchini A, Dell'Osso L: A relationship between oxytocin and anxiety of romantic attachment. Clin Pract Epidemol Ment Health 2006;2:28
94. Declerck CH, Boone C, Kiyonari T: Oxytocin and cooperation under conditions of uncertainty: the modulating role of incentives and social information. Horm Behav 2010;57:368-374
95. Hoge EA, Pollack MH, Kaufman RE, Zak PJ, Simon NM: Oxytocin levels in social anxiety disorder. CNS Neurosci Ther 2008;14:165-170
96. Meinlschmidt G, Heim C: Sensitivity to intranasal oxytocin in adult men with early parental separation. Biol Psychiatry 2007;61:1109-1111 (Pubitemid 46551976)
97. Zahn R, Moll J, Krueger F, Huey ED, Garrido G, Grafman J: Social concepts are represented in the superior anterior temporal cortex. Proc Natl Acad Sci USA 2007;104:6430-6435 (Pubitemid 47186111)
98. Preter M, Lee SH, Petkova E, Vannucci M, Kim S, Klein DF: Controlled cross-over study in normal subjects of naloxone-precedinglactate infusions; respiratory and subjective responses: relationship to endogenous opioid system, suffocation false alarm theory and childhood parental loss. Psychol Med 2011;41:385-393