Subjects
This report is based on a group of patients who presented seeking relief from a primary complaint of anxiety in two ambulatory settings for the treatment of anxiety. They represent a convenience sample gathered from sequential admissions,
equally derived from a hospital and community outpatient clinic during the spring and summer of 1986. The subjects selected had scored one SD above the mean on the Spielberger Trait Inventory (STAI) as well as scoring one SD below the mean on the Zung Scale for Depression (SDS). Diagnostically, the group demonstrated both significant depression as well as anxiety which co-occurred with panic attacks and agoraphobia. The group is similar to the patients defined by Van Valkenburg et al. (30) as the anxious depression group (24,25). Our goal was to report on anxiety patients with low and high depression scores, but of the 15 clients sampled, all clustered in the median-high or high-high categories for both depression and anxiety (Table 1). Although there is some overlap in the STAI and SDS measures, which may contribute to the co-occurrence (13), the clustering of individuals in this way is in itself an interesting finding considering the focus of this volume. We thus restricted our research to two groups, a high anxiety/moderate depression group (N = 6) and a high anxiety/high depression group (N = 5). Findings thus compare two high anxiety groups that differ from one another by one SD on reports of affective disturbances measured on the SDS (Table 1). RESULTS The two groups are compared using three types of data. First, we present variations in ecological descriptions and time allocation; second, we present differences in the self-rating of mental state; and third, we describe temporal Phenomena of depression and anxiety. Table 2 shows differences in frequency distributions of the ES variables between the two groups. For all coded ES categories (except thought-activity congruence), strong differences were found. The groups differed in thought-content, expressed psychopathology, where they were, what they were doing, and with whom they were. A more detailed breakdown of these differences in global categories is instructive.
For example, thought-content differentiated the groups. In this cluster, thoughts about leisure were found 10% of the time in the medium depressed group and 21% in the highly depressed group; "thinking about nothing" was found 1 % in the medium group and 8% in the high group, and thoughts about work were found 11% in the medium group and 25% in the high group. For the category psychopathology, in this case excessive worrying and rumination, occurred 2% of the time in the medium group and 11% in the high group. In terms of activities, the medium group was found to be involved in self-care 7% of the time and the high group 14% of the time, and inversely the medium group was caring for others 18% of the time, but the high group did so only 7% of the time. The medium depressed group was also found significantly more in public places than the high group. The variable "whom they were with" also differentiated the groups. Although both groups were alone a relatively equal amount of time, 21% and 26%, the medium depressed group interestingly spent 47% of their time with family and the highly depressed only 33%. For friends and colleagues this relationship switched, and the medium depressed group was with friends 13% of the time and the high group 23% of the time. In summary, the highly depressive group had more idle thoughts, ruminated more, experienced less focused thoughts in public, and registered most self-care and less care and involvement with others. Socially, the high depression group was at home more and with the family less. They also tended to report more diffuse and vague somatic and psychological complaints than the moderately depressed group. These findings are in accordance with clinical characteristics of this group as having a higher degree of morbidity than individuals with only anxiety or depression alone. In Fig. 1 (these relationships are plotted using the likelihood that an individual will be found in the same place upon two sequential signals indicated as percentages for the variable "where") we observe a subtle and dynamically different picture for each group. The medium group demonstrated a more diverse and dynamic network with quantitatively more social contexts and transitions from
FIG. 1. Setting changes from time f to time f + 1. (A): Medium depressed anxious subjects. (B) Highly depressed anxious subjects. place to place being recorded. The figure is also offered to demonstrate one way that ES data may be used to provide a quantitatively derived picture of the social network of patients with different disorders.