A longitudinal study of the intrusiveness of cognitions in test anxiety

Mental imagery in dentistry: Phenomenology and role in dental anxiety

Dental anxiety is a prevalent problem with marked psychological, physical and public health implications. Based on cognitive theory and evidence, we hypothesized that vivid, sensory image-based cognitions play a role in dental anxiety. A quantitative online survey (N = 306) and qualitative semi-structured interviews (N = 18) found that vivid sensory images were common irrespective of dental anxiety levels, but that their content, associated distress and responses varied. Participants reporting higher anxiety experienced intense and intrusive fear-provoking dental imagery focusing on unpleasant sensations, which were associated with the intrusive recollection of negative past experiences and avoidance of dentistry. Participants with lower anxiety ratings, reported images that were less distressing and centered around reassuring aspects and positive appointment outcomes, potentially acting as protective factors against dental anxiety and facilitating appointment attendance. The inclusion of components aimed at reducing intrusive memories and dental imagery rescripting may help improve interventions for dental anxiety.

From intrusive to oscillating thoughts

This paper focused on the possibility that intrusive thoughts (ITs) are a form of an evolutionary, adaptive, and complex strategy to prepare for and resolve stressful life events through schema formation. Intrusive thoughts have been studied in relation to individual conditions, such as traumatic stress disorder and obsessive-compulsive disorder. They have also been documented in the average person experiencing everyday stress. In many descriptions of thought intrusion, it is accompanied by thought suppression. Several theories have been put forth to describe ITs, although none provides a satisfactory explanation as to whether ITs are a normal process, a normal process gone astray, or a sign of pathology. There is also no consistent view of the role that thought suppression plays in the process. I propose that thought intrusion and thought suppression may be better understood by examining them together as a complex and adaptive mechanism capable of escalating in times of need. The ability of a biological mechanism to scale up in times of need is one hallmark of a complex and adaptive system. Other hallmarks of complexity, including self-similarity across scales, sensitivity to initial conditions, presence of feedback loops, and system oscillation, are also discussed in this article. Finally, I propose that thought intrusion and thought suppression are better described together as an oscillatory cycle.

The dynamics of threat and challenge appraisals prior to stressful achievement events

Research on cognitive appraisal of stressful achievement events has emphasized threat appraisals and anxiety. The present research also focused on challenge and positive emotion. Study 1 used hypothetical scenarios of stressful events. Study 2 explored temporal pattems of appraisal and emotion prior to an exam. Compared with threat appraisals, trait and state challenge appraisals were associated with more confident coping expectancies, lower perceptions of threat, higher positive emotion, and more beneficial perceptions of the effects of appraisal and emotion on performance. Beneficial perceptions of state appraisals were associated with higher exam performance. These findings were interpreted in the context of theoretical perspectives on the cognitive appraisal of stressful events and the adaptive functions of challenge and positive emotion.

Children's self-talk under conditions of mild anxiety

Two studies are described which used think-aloud (Study 1) and verbal thought-listing (Studies 1 and 2) procedures to assess preadolescent children's self-talk under conditions of mild anxiety. The self-talk reported was coded into six theoretically meaningful categories and the relationship between self-talk type and anxiety (state and trait) examined. Increased levels of anxiety were associated with higher rates of negative self-talk, but not clearly associated with other types of self-talk. These results suggest negative self-talk plays a role in the generation or maintenance of anxiety in normal children. From the data, it is unclear to what extent perceived task difficulty contributes to the relationship between trait anxiety and negative self-talk. Assessment of self-regulation (Study 1) identified higher levels of anxiety in children reporting awareness of strategies for managing their anxiety.

Intrusive cognitions, coping strategies and emotional responses in depression, post-traumatic stress disorder and a non-clinical population

Patients with major depression but not PTSD, patients with PTSD with or without comorbid depression, and a sample of non-clinical controls, were interviewed about their most prominent intrusive cognition, coping strategies and emotional responses. Evaluative thoughts were more likely to be reported by the depressed sample and the control sample. They were also common in the PTSD group, but other types of intrusions were also common, particularly personal memory. All three groups reported a wide variety of different types of intrusive cognition, both singly and in combination. These included elaborative cognitions, future-oriented thoughts or images that represented an elaboration of a specific personal memory. Cognitions were more frequent, unacceptable, and intrusive in the PTSD group in the month preceding interview, but the two clinical groups did not differ in the use of or effectiveness of coping strategies, or in emotional responses.

Cognitive intrusions in a non-clinical population. II. Associations with depressive, anxious, and compulsive symptoms

The relationships between experimental dimensions of cognitive intrusions and depressive, anxious, and compulsive symptoms were studied among 125 university students. The students completed a questionnaire describing and evaluating seven cognitive intrusions and inventories of depressive, anxious, and compulsive symptoms. Principal component factor analysis on the 14 cognitive intrusion questionnaire dimensions identified five factors that were interpreted as general distress, evaluation, control, diversity and attention. Hierarchical regression analysis showed that effortful strategies in response to cognitive intrusions, general distress and diversity were predictors of both Beck Depression and Beck Anxiety Inventory scores. The evaluation factor consisting of perceived responsibility, disapproval and guilt ratings was also associated with depression and was the only significant predictor of Compulsive Activity Checklist scores. The control factor, consisting of items describing successful application of response strategies, was negatively related to BAI scores. The results are discussed as providing support for Salkovskis' formulation of obsessive-compulsive disorder.

Cognitive intrusions in a non-clinical population. I. Response style, subjective experience, and appraisal

The present study identified distinctive response styles to unpleasant cognitive intrusions to further understanding of intrusive phenomena similar to those observed in obsessive-compulsive disorder and other anxiety disorders. Response styles were studied among 125 university students who completed a questionnaire describing and evaluating seven cognitive intrusions and inventories of depressive, anxious, and compulsive symptoms. Almost all subjects (99%) reported intrusions and 92% included effortful strategies in response to intrusions in their repertoire. Large differences were observed in the dominant strategy used. Three distinctive dominant response styles were identified including no effortful response (26%) and two effortful styles, attentive thinking (34%), and escape/avoidance (40%). The two groups using effortful strategies were more anxious and reported more difficulty removing intrusions. The group using escape/avoidance strategies reported more sadness, worry, guilt, and disapproval than subjects reporting no effortful response. The attentive thinking group reported more varied forms and more frequently triggered intrusions then the no effortful response group. Within subject analyses support the group comparisons and showed that intrusions eliciting escape/avoidance strategies were evaluated more disapprovingly than thoughts eliciting attentive thinking. The results are discussed in terms of Salkovskis' (Behavior Research and Therapy, 27, 677-682, 1985) formulation of obsessive-compulsive disorder and Borkovec's (Journal of Consulting and Clinical Psychology, 23, 481-482, 1985) and Barlow's (Anxiety and its disorders: The nature and treatment of anxiety and panic, 1988) discussions of worry and generalized anxiety.