Questions & Answers by Padesky
The following is a sampling of some of the Questions we received along with Dr Christine Padesky’s answer to them.
Correspondents consented to publication of their question and follow-up response for educational purposes
QUESTION: I use the Mind Over Mood depression and anxiety inventories with my clients. Do you have cut-off scores and norms I can reference?
ANSWER: from Christine A. Padesky, Phd
We do not have established norms for our Mind Over Mood Depression Inventory (MOM-D) or Mind Over Mood Anxiety Inventory (MOM-A). The Mind Over Mood inventories are more appropriate to use for self-monitoring and to compare client scores over time and document progress in therapy. They are not used to classify depression severity.
To provide cut-off scores on the inventories related to likely depression severity we would need data on several thousand people. To my knowledge, no one has conducted the large scale studies required to determine their testing properties. However, research studies (see attachments) have examined the concurrent validity of our scales with the Beck Depression and Anxiety Inventories which have been widely used in research. Scores on the MOM-D and MOM-A are highly correlated with scores on the Beck inventories.
Thus, since the Mind Over Mood inventories have a similar number of items as the Beck inventories, I usually informally advise clinicians that they can use the Beck scoring guides as a rough approximation for our inventories. For example, scores in the mid-teens on the MOM-D probably indicate mild depression, scores above 20 moderate depression, scores above 30 may indicate more serious depression. However, as is true with all depression self-report measures, scores can vary from individual to individual.
In summary, no self-report questionnaire can be used for diagnostic purposes or as an exact guide to an individual’s level of depression. However, variations in an individual’s scores over time can and usually do reflect mood improvement or worsening. Thus, we recommend clinicians use the MOM-D and MOM-A to track an individual’s response to treatment. Clients can use changes in scores to track the impact of skills practice.
Beal, D., Cox, T., Brittain, S, Brubaker, R., & Falkenberg, S. (2004) The concurrent validation of the Mind Over Mood Depression Inventory. Presented at the annual meeting of the Southeastern Psychological Association, Atlanta, GA.
VIEW / DOWNLOAD PDF (Depression)
Cox, T., Beal, D., and Brittain, S. (2004). The concurrent validity of the Mind Over Mood Anxiety Inventory. Presented at the annual meeting of the Southeastern Psychological Association, Atlanta, GA.
VIEW / DOWNLOAD PDF (Anxiety)
- Highlights the importance of understanding principles of anxiety treatment so you can troubleshoot the unexpected when using treatment protocols
- Please note that the follow-up response at the end of Padesky’s reply provides critical corrective information
QUESTION: DEAR DR. PADESKY
Hi, could you clarify something please? I’ve been telling clients for years, following your workshops, that they cannot faint in a panic attack, and explaining why. Then the other day I had a client tell me he frequently did faint in a panic attack. I checked with his doctor who said nothing else [medically] was going on and the doctor assured me that hyperventilating in a panic attack can cause fainting – ??? Hope you can help with this.
— Thanks Julia
ANSWER: FROM CHRISTINE A. PADESKY, PhD
It was a good idea to consult with your client’s physician first to see if there might be a medical cause of the fainting. Unfortunately, what the physician told you is not consistent with what I’ve been told by physicians over the years. As the Freedom From Fear website (www.FreedomFromFear.org) states:
Panic will not make you faint; While you faint for a variety of reasons that may have nothing to do with panic attacks, (heat, exhaustion, dehydration, poor nutrition, etc.) panic WILL NOT make you faint. When you faint your blood pressure must go down, when you’re having a panic attack your blood pressure is going sagely up, not down. (reference: www.freedomfromfear.org/aanx_factsheet.asp?id=10)
There are several issues raised by your client’s experience:
First, people often say they “fainted” when they felt faint and “needed to sit down.” It is necessary to interview carefully to find out if the person actually lost consciousness as occurs in actual fainting. People do often feel faint when hyperventilating or having a panic attack. While feelings of lightheadedness can be so intense they are labeled “fainting,” the person does not lose consciousness during a panic attack which is part of panic disorder.
Fainting can occur under a variety of situations that can co-occur with panic attacks such as hunger, viral infection, allergy, vertigo from an inner ear disorder, anemia, sinusitis, heat exhaustion, poor eating habits, low blood sugar, salt depletion, standing up quickly, pressure on the vasovagal nerve (e.g., in pregnancy), etc. If fainting is verified, interview to find out if any of these were present when the client fainted. As I may have mentioned in my workshop, one man had been thoroughly tested by a neurologist who ruled out any physical cause for his fainting. Later tests found a small tumor in his brain that was pressing on a nerve and was missed in earlier tests.
As a third point, panic attacks can occur within any anxiety disorder not just panic disorder. It is important to interview and find out what thoughts and images were going through the person’s mind in the middle of the panic attack. With panic disorder you get beliefs such as “I’m having a heart attack.” “If I faint, I will stop breathing and die.” In social anxiety you get thoughts during panic such as “if others see how anxious I am, they will think I am a mental case.” In blood phobia you get thoughts such as “if I see blood I will faint” (which may be true for the reasons in the next paragraph).
If the panic attack is a symptom of severe anxiety when the person has a blood phobia, they would indeed be likely to faint. In blood phobia there is a rapid DROP in blood pressure which leads to fainting. Over time, a person can become so anxious when the anticipate seeing blood or an injury that they become anxious to the point of panic and simultaneously have the drop in blood pressure associated with blood phobia. This would not be diagnosed as panic disorder (and so you would not use hyperventilation as part of treatment) but instead as a blood phobia. Interestingly, the treatment for blood phobia involves teaching the client to raise their blood pressure in the presence of blood or injury through various muscle tightening exercises.
Thus, you need to be a bit of a detective when the client reports fainting during a panic attack. It is important to question with compassionate curiosity (expressing concern for your client) because the client can otherwise think you doubt their veracity.
Please let me know what you learn from your client.
— Christine A. Padesky, PhD
FOLLOW-UP RESPONSE FROM JULIA
Dear Dr Padesky,
Thank you so much for taking the time to answer personally.
I think the client does indeed have blood/injury phobia – which I had never heard of. He does actually faint, and all his triggers are related to blood tests, injuries, hospitals etc. It would also be consistent with a traumatic hospitalization when he was a toddler.
I’m fascinated that the effect of this on blood pressure is the opposite to what happens in panic disorder! I now need to learn more about my interventions.
Thank you for clearing up my mystery and pointing me in the right direction.
— Best Regards, Julia