FEAR AND AVOIDANCE OF MEDICALLY-RELATED TREATMENT AND DIAGNOSTICS:
1. The nature and consequences of Blood, Injection, Injury fears and phobias: This research includes construction and validation of a factorially derived, five factor scale designed to assess medical fears (the Medical Fear Survey, MFS) and a three factor, companion scale to assess reported fear motivated avoidance (the Medical Avoidance Survey, MAS). See Kleinknecht, Thorndike, & Walls, 1996. This program investigates several sources of fear associated with avoidance of medical treatment and the negative consequences of that avoidance.
2. Psychological precursors to and cognitions associated with, injection and blood - related vasovagal fainting. This facet of the program investigates the relationship between blood-injection-injury (BII) stimuli and the occurrence and onset of vasovagal reactions (fainting, nausea, etc.). In particular, we are investigating the relative contributions of the emotions of fear and of disgust of BII stimuli, to elicitation of the vasovagal reaction. (See Penner & Kleinknecht, 1994; Kleinknecht, Thorndike, Tolin, & Lohr, 1996; Kleinknecht, Thorndike, & Kleinknecht, (1997). Our current data suggest that fear is the primary determinant of fainting in BII situations. disgust is either not related or is inversely related to fainting symptoms in our latest data set. (Kleinknecht, et al., 1997).
3. Reduction of BII fears and phobia in order to facilitate use of medical treatment and diagnostic services. This segment of the BII program is devoted to developing efficient and efficacious treatments of BII-related fear and vasovagal reactions. (Kleinknecht, 1994). Also a part of this program is the investigation of fear-related reluctance to donate blood and the development of fear-reduction programs to enable fearful "would-be" donors to become actual blood donors.
4. Recruitment of blood donors and psychosocial characteristics of donors and non-donors. This component of our program examines donor recruitment procedures designed to increase the donor pool. Here we are focusing on University students, providing information, modeling, and normative social influences by way of lecture and videotape presentation with the goal of recruitment for upcoming blood drives on campus. Our first study, completed as a Masters thesis by Lisa Tieber (1997), found no differences between an informational lecture and the same lecture plus a videotaped presentation that included, accident victims' testimonials, information and modeling of donation procedures (Sarason, et al., 1995). Overall, 15.8% the classes that received either of these procedures attempted to donate blood compared with 3.4% of the general population students.
Donors scored higher on empathic Concern and were less needle injection fearful than non-donors. Discriminant analysis showed that donor status was best predicted by a composite of Social Assistance Scale scores (SAS) and MFS, fear of injections and blood draws. Reasons given for donating blood were consistent with altruistic-like motives ("I like to help others in need.") while the major reasons for not donating were fear of needles and blood draws. However, 7% reported avoidance due to fear of contracting AIDS. In the present study it appeared that helping/altruism was the strongest predictor of donation. We have just completed data collection on a larger scale study to replicate the Tieber et al., findings. Again, we explore whether donation is a product of positive factors such as altruistic-like helping behaviors and avoidances due to fear of injections, blood draws, vasovagal symptoms and the like. We anticipate these data to be available by May, 1998.
This research program examines conditions under which fears and phobias develop. It is clear that everyone experiencing traumas, whether direct or vicarious, does not develop long lasting fears, phobias, or Posttraumatic stress symptoms. We investigate subject, dispositional, antecedent, and current situational variables relevant to traumatic situations that differentiate those who develop phobias from those who do not. Our research has examined the relative contributions of direct trauma, vicarious experiences, and mis-information on development of injection fears (Kleinknecht, 1995). A subsequent study compared this distribution of pathways to fear as a function of the method by which acquisition information was obtained (interview versus questionnaire). This information was then cross-validated by querying informants' parents concerning their recollections of their children's fear onset (Kheriaty, Kleinknecht, & Hyman, in press). We are currently examining positive versus negative experiences with several phobic stimuli ( e.g. dog, spiders, BII, and heights) in relation to current fears (Erica Kleinknecht, Masters thesis, 1997). This program is being conducted in collaboration with Dr. Ira Hyman. We currently planning a replication of the Kheriaty et al., studywith children for Joni Roman's Masters Thesis.
CROSS-CULTURAL VARIATION IN ANXIETY EXPRESSION:
Taijin Kyofusho, (TKS), is a variation of social anxiety and phobia, prevalent in Japan and some other Asian countries. TKS litterally means fear (kyofu), syndrome (sho), experienced in social or public situations in which people have direct eye contact with one another (Taijin). In Japan, social anxiety is expressed as a fear that one's behavior or appearence will offend others. In contarast, in the West, social anxiety is based largely on fear that one will humiliate oneself or become the object of scrutiny. We devised a scale to assess this "fear of offending others" and administered it, along with the Mattick Social Phobia Scale and the Social Interaction Avoidance Scale, to samples of United States and Japanese university students. This study was designed to explore similarities and differences in social anxiety between these two culturally different groups as a function of construal of the self as either interdependent or independent, assessed by the Singelis, Self-Construal Scale, (Kleinknecht, Dinnel, Kleinknecht, Hiruma, & Harada, (1997) , Journal of Anxiety Disorders. This research program is being conducted in collaboration with Dr. Dale Dinnel.
RECREATION AND TREATMENT OF MULTIPLE PHOBIAS:
(Photo, courtesy of Karen Casto, 1997)