The overprediction of fear: a review

Voter emotional responses and voting behaviour in the 2020 US presidential election

Political polarisation in the United States offers opportunities to explore how beliefs about candidates - that they could save or destroy American society - impact people's thoughts, feelings, and behaviour. Participants forecast their future emotional responses to the contentious 2020 U.S. presidential election, and reported their actual responses after the election outcome. Stronger beliefs about candidates were associated with forecasts of greater emotion in response to the election, but the strength of this relationship differed based on candidate preference. Trump supporters' forecast happiness more strongly related to beliefs that their candidate would save society than for Biden supporters. Biden supporters' forecast anger and fear were more strongly related to beliefs that Trump would destroy society than vice versa. These forecasts mattered: predictions of lower happiness and greater anger if the non-preferred candidate won predicted voting, with Biden supporters voting more than Trump supporters. Generally, participants forecast more emotion than they experienced, but beliefs altered this tendency. Stronger beliefs predicted experiencing more happiness or more anger and fear about the election outcome than had been forecast. These findings have implications for understanding the mechanisms through which political polarisation and rhetoric can influence voting behaviour.

The Effectiveness of a Digital App for Reduction of Clinical Symptoms in Individuals With Panic Disorder: Randomized Controlled Trial

BACKGROUND

Panic disorder is a common and important disease in clinical practice that decreases individual productivity and increases health care use. Treatments comprise medication and cognitive behavioral therapy. However, adverse medication effects and poor treatment compliance mean new therapeutic models are needed.

OBJECTIVE

We hypothesized that digital therapy for panic disorder may improve panic disorder symptoms and that treatment response would be associated with brain activity changes assessed with functional near-infrared spectroscopy (fNIRS).

METHODS

Individuals (n=50) with a history of panic attacks were recruited. Symptoms were assessed before and after the use of an app for panic disorder, which in this study was a smartphone-based app for treating the clinical symptoms of panic disorder, panic symptoms, depressive symptoms, and anxiety. The hemodynamics in the frontal cortex during the resting state were measured via fNIRS. The app had 4 parts: diary, education, quest, and serious games. The study trial was approved by the institutional review board of Chung-Ang University Hospital (1041078-202112-HR-349-01) and written informed consent was obtained from all participants.

RESULTS

The number of participants with improved panic symptoms in the app use group (20/25, 80%) was greater than that in the control group (6/21, 29%; χ21=12.3; P=.005). During treatment, the improvement in the Panic Disorder Severity Scale (PDSS) score in the app use group was greater than that in the control group (F1,44=7.03; P=.01). In the app use group, the total PDSS score declined by 42.5% (mean score 14.3, SD 6.5 at baseline and mean score 7.2, SD 3.6 after the intervention), whereas the PDSS score declined by 14.6% in the control group (mean score 12.4, SD 5.2 at baseline and mean score 9.8, SD 7.9 after the intervention). There were no significant differences in accumulated oxygenated hemoglobin (accHbO2) at baseline between the app use and control groups. During treatment, the reduction in accHbO2 in the right ventrolateral prefrontal cortex (VLPFC; F1,44=8.22; P=.006) and the right orbitofrontal cortex (OFC; F1,44=8.88; P=.005) was greater in the app use than the control group.

CONCLUSIONS

Apps for panic disorder should effectively reduce symptoms and VLPFC and OFC brain activity in patients with panic disorder. The improvement of panic disorder symptoms was positively correlated with decreased VLPFC and OFC brain activity in the resting state.

TRIAL REGISTRATION

Clinical Research Information Service KCT0007280; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=21448.

Mechanisms of Action in Exposure Therapy

PURPOSE OF REVIEW

Exposure therapy is an effective treatment for anxiety-related disorders, but many individuals do not achieve full symptom relief, and return of fear is a common occurrence. Understanding how exposure therapy works enables further development of strategies to improve its effectiveness.

RECENT FINDINGS

Recent studies have examined mechanisms of exposure-based interventions across multiple levels of analysis, from cognitive and behavioral changes that occur during treatment to the neurobiological mechanisms underlying fear extinction. Belief change and reductions in safety behaviors and avoidance mediate symptom improvements during exposure therapy, suggesting plausible cognitive and behavioral mechanisms. On the neural level, increased activation of prefrontal regions during extinction learning is a likely mechanism of exposure. Improved understanding of the biological mechanisms of exposure have led to exciting developments in clinical research, including pharmacological augmentation, though clinical translation of basic research has produced mixed results. Though still in development, such translational research is a promising future direction for exposure-based interventions.

Cognitive Restructuring Before Versus After Exposure: Effect on Expectancy and Outcome in Individuals With Claustrophobia

Maximizing the discrepancy between expected and actual outcomes during exposure (i.e., expectancy violation) is thought to optimize inhibitory learning. The current study examined Craske et al.’s suggestion that engaging in cognitive restructuring (CR) before exposure prematurely reduces expectancy and mitigates outcomes. Participants (N = 93) with claustrophobia were randomly assigned to either 15 minutes of CR before exposure (CR Before) or 15 minutes of CR after exposure (CR After). Although the CR Before condition experienced greater expectancy reduction before exposure than the CR After condition, both groups experienced similar overall expectancy reduction by the end of the intervention. Groups experienced similar gains, with large significant improvement at posttreatment and follow-up. Results suggest that both cognitive therapy and exposure therapy lead to expectancy reduction, but that the order of these interventions does not impact outcome. Clinicaltrials.org registration #NCT03628105.

Socioeconomic Impacts of the COVID-19 Lockdown on the Mental Health and Life Satisfaction of the Japanese Population

COVID-19 has been a global challenge ever since its emergence, with reports suggesting negative effects on the mental health and well-being of people. We investigated the associations of the socioeconomic changes driven by the pandemic, illness, well-being, and fear of COVID-19 in Japan. Totally, 565 Japanese individuals completed an online survey, including questions on their self-restraint and changing incomes, and the Fear of COVID-19 Scale; Depression, Anxiety, Stress Scale; and present, past, and future life satisfaction scale. Analysis using structural equation models revealed that refraining from going out was a predictor of illness due to the fear of COVID-19. Decreased income predicted increased illness, but was not due to fear of COVID-19. These results suggested that the interaction between decreased time outside and increased fear of COVID-19 could affect illness. Our study suggests the role of fear of COVID-19 during pandemic and the socioeconomic impacts on mental health.

Do We Know What We Enjoy? Accuracy of Forecasted Eating Happiness

Forecasting how we will react in the future is important in every area of our lives. However, people often demonstrate an "impact bias" which leads them to inaccurately forecast their affective reactions to distinct and outstanding future events. The present study examined forecasting accuracy for a day-to-day repetitive experience for which people have a wealth of past experiences (eating happiness), along with dispositional expectations toward eating ("foodiness"). Seventy-three participants (67.12% women, M age = 41.85 years) used a smartphone-based ecological momentary assessment to assess their food intake and eating happiness over 14 days. Eating happiness experienced in-the-moment showed considerable inter-and intra-individual variation, ICC = 0.47. Comparing forecasted and in-the-moment eating happiness revealed a significant discrepancy whose magnitude was affected by dispositional expectations and the variability of the experience. The results demonstrate that biased forecasts are a general phenomenon prevalent both in outstanding and well-known experiences, while also emphasizing the importance of inter-individual differences for a detailed understanding of affective forecasting.

The role of concern about falling on stepping performance during complex activities

Background

There is limited understanding of the underlying mechanisms explaining the role of concern about falling on fall risk in older people. Anxiety is known to interact with cognitive resources and, as people get older, they require more cognitive resources to maintain balance. This might affect an individual’s ability to perform cognitive-motor tasks concurrently. The aim of this study was to investigate the effect of a visuospatial dual-task on stepping performance in older people with and without concern about falling and the impact of repeating this task in those with high concern about falling.

Methods

Three-hundred-eight community-dwelling older people, aged 70 to 90 years old, participated in the study. Participants were asked to perform a Choice Stepping Reaction Time (CSRT) task in two conditions; once without any other tasks (single task condition), and once while simultaneously performing a visuospatial task (dual-task condition). Participants were asked to rate their levels of concern and confidence specifically related to each of the 25 stepping trials (before/after). We also measured general concern about falling, affect, and sensorimotor and cognitive functioning.

Results

Total stepping reaction times increased when participants also performed the visuospatial task. The relation between general concern about falling and stepping reaction time, was affected by sensorimotor and executive functioning. Generalised linear mixed models showed that the group with moderate to high levels of general concern about falling had slower total stepping reaction times than those with lower levels of concern about falling, especially during the dual-task condition. Individuals with greater general concern about falling showed reduced confidence levels about whether they could do the stepping tasks under both conditions. Repeatedly performing the stepping task reduced the immediate task-specific concern about falling levels and increased confidence in all participants.

Conclusions

These findings reveal that people with higher general concern about falling experienced more difficulties during a dual-task condition than people with lower levels of concern. Of further interest, better sensorimotor and cognitive functioning reduced this effect. Graded exposure has potential to reduce concern about falling during fear-evoking activities, especially in conjunction with therapies that improve balance, mood and cognitive function.

Prediction Errors in Depression: A Quasi-Experimental Analysis

The overprediction and underprediction of fear, pain, and other constructs have been linked with etiology and maintenance of anxiety disorders. We aimed to extend this research to depression by investigating the overprediction of effort and the underprediction of reward and enjoyment associated with a simple task. Participants with depression (n = 20) and a control group (n = 40) predicted how much effort and reward/enjoyment would be experienced during a short walk around the university. Post-walk, participants reported the actual effort required and the actual experienced reward and enjoyment. Compared to the control group, who demonstrated accurate predictions, depressed individuals significantly overpredicted the required effort associated with the walk even though there were no between-group differences in actual effort required. There was no evidence to suggest that the depressed group underestimated or were inaccurate in their predictions of walk-related reward and enjoyment relative to the control group. Implications for cognitive and behavioral approaches to depression are discussed.

Probabilistic Learning by Positive and Negative Reinforcement in Generalized Anxiety Disorder

This experiment examined learning tendencies in generalized anxiety disorder (GAD) using reinforcement feedback for probabilistic outcomes. One hundred sixty-six GAD and 105 non-GAD participants were randomized to a computerized probabilistic learning task that used either negative or positive reinforcement. Participants chose between stimuli with specific probabilities of reinforcement to learn which of each pair had the highest probability. Reinforced choices either removed an angry face (negative reinforcement) or made a happy face appear (positive reinforcement). Results showed that those with GAD learned the correct probabilistic choices at a slower rate over time and to a lesser degree than control participants regardless of reinforcement type. Estimations of the likelihood of receiving a good outcome posttask were also more inaccurate for those with GAD, especially when true likelihoods were high. Furthermore, compared with control participants, those with GAD reported lower perceived reinforcement sensitivity, higher behavioral inhibition sensitivity, and higher undesirable feelings toward probabilistic learning.

Welfare effects of nudges: The emotional tax of calorie menu labeling

Traditionally, information has been assumed to never harm consumers, a notion recently challenged. Salience nudges have been argued to evoke negative emotions, therefore acting as “emotional taxes”. I design a hypothetical restaurant meal experiment to analyze the emotional and short-term consumer welfare impact of a calorie salience nudge (calorie menu labeling) – a policy implemented nationwide in the U.S. in 2018. I find that a calorie salience nudge may act as an emotional tax, but only for some – there is considerable heterogeneity in the emotional response to the nudge. In particular, the nudge emotionally taxes people with low eating self-control, while it emotionally subsidizes those with higher levels of eating self-control. It therefore emotionally taxes the “right” people. However, people with lower levels of self-control may experience fewer benefits from the nudge – the nudge causes them to adjust their high calorie meal consumption by less than do those with higher self-control. It is therefore unsurprising that consumers with lower self-control attach a lower (a negative) value to the calorie salience nudge. Overall, the calorie salience nudge positively affects consumer welfare, although heterogeneity over consumers is substantial – the consumer value ranges from positive to negative. I find no distributional effects over income from the calorie salience nudge.

That Was Easy! Expectancy Violations During Exposure and Response Prevention for Childhood Obsessive-Compulsive Disorder

Violating expectancies during exposure therapy is proposed to promote inhibitory learning and improved treatment outcomes. Because people tend to overestimate how distressing emotionally challenging situations will be, violating expectations of distress may be an intuitive way to promote treatment outcome during exposure-based cognitive-behavioral therapy (CBT). This study evaluated overpredictions of distress during exposure tasks in 33 youth with obsessive-compulsive disorder (OCD; ages 8-17) participating in CBT. Youth with more variable prediction accuracy and a higher proportion of overpredictions experienced more rapid symptom reduction, b = -0.29, p = .002. Underpredictions were less common toward the end of therapy as youth experienced less severe OCD, b = 0.12, p= .001. Findings suggest that although youth often accurately predict the intensity of exposure, overpredictions are common as well. The frequency of these overpredictions promoted treatment outcome, supporting expectancy violations as one indicator of inhibitory learning during exposure therapy.

Opposing Subjective Temporal Experiences in Response to Unpredictable and Predictable Fear-Relevant Stimuli

Previous studies have found that the durations of fear-relevant stimuli were overestimated compared to those of neutral stimuli, even when the fear-relevant stimuli were only anticipated. The current study aimed to investigate the effect of the predictability of fear-relevant stimuli on sub-second temporal estimations. In Experiments 1a and 1b, a randomized design was employed to render the emotional valence of each trial unpredictable. In Experiments 2a and 2b, we incorporated a block design and a cueing paradigm, respectively, to render the emotional stimuli predictable. Compared with the neutral condition, the estimated blank interval was judged as being shorter under the unpredictable fear-relevant condition, while it was judged as being longer under the predictable fear-relevant condition. In other words, the unpredictable and predictable fear-relevant stimuli led to opposing temporal distortions. These results demonstrated that emotions modulate interval perception during different time processing stages.

Short versions of two specific phobia measures: The snake and the spider questionnaires

Zoophobias are the most prevalent form of specific phobia worldwide. Two of the most widely used measures, the Snake Questionnaire (SNAQ) and Spider Questionnaire (SPQ) are good indicators of specific fears, but researchers have recognised that shorter, yet nevertheless reliable measures are needed. Hence the aims of this research were to develop short forms of the SNAQ and SPQ using item response theory and to use receiver operating characteristic (ROC) curve analyses to determine cut-offs for use in future research. Twelve-item versions of both scales (SNAQ-12 and SPQ-12) demonstrated excellent discrimination along the latent continuum in a sample of 1354 people. The SNAQ-12 and SPQ-12 showed excellent reliability and were highly correlated with the corresponding full-length scale. The scales discriminated between participants who reported snake (3.25%) or spider (8.05%) phobia and those who did not. Further analyses revealed that non-phobic women report higher fear of both snakes and spiders than do men, but this difference was not present in phobics. These findings suggest that the SNAQ-12 and SPQ-12 have considerable strengths, including shorter assessment and scoring times, whilst retaining high reliability and potential utility as a clinical screening tool.

The spider and the snake - A psychometric study of two phobias and insights from the Hungarian validation

Specific phobias-particularly zoophobias-are prevalent worldwide and can have fairly dramatic health consequences. Self-report measurements play a crucial role in phobia research studies; thus, it is important to have a reliable tool in different languages. The present investigation examined the psychometric properties of the Hungarian version of two commonly used measures of fear: the Spider Phobia Questionnaire (i.e. SPQ) and the Snake Questionnaire (i.e. SNAQ). The SPQ and SNAQ scores both demonstrated excellent reliability, including a test-retest over a 4-week period. Supportive evidence for the validity of the SPQ and SNAQ scores was found using questions assessing fainting and avoidance history, regarding snakes and spiders, based on DSM-V criteria. Both questionnaires could discriminate between participants who reported such an event and those who did not. Further analyses also revealed a sex difference, with women scoring higher than men on both scales. Moreover, 9.5% and 4.24% of the respondents reached the cut-off point, set by previous studies, for spider and snake phobias, respectively. These findings suggest that the SPQ and SNAQ have excellent psychometric properties, making them suitable for use in further cross-cultural research and epidemiological studies.

The moderating role of avoidance behavior on anxiety over time: Is there a difference between social anxiety disorder and specific phobia?

Theories of anxiety disorders and phobias have ascribed a critical role to avoidance behavior in explaining the persistence of fear and anxiety, but knowledge about the role of avoidance behavior in the maintenance of anxiety in social anxiety disorder relative to specific phobia is lacking. This study examined the extent to which avoidance behavior moderates the relationship between general anxiety at baseline and 18 months later in women with a diagnosed social anxiety disorder (n = 91) and women with a diagnosed specific phobia (n = 130) at baseline. Circumscribed avoidance of social and specific situations were clinician-rated using the Anxiety Disorders Interview Schedule-Lifetime (ADIS-IV-L), and general anxiety was measured using the Beck Anxiety Inventory (BAI). Moderated regression analyses revealed that (a) general anxiety at baseline predicted general anxiety at follow-up in both women with a specific phobia and women with a social anxiety disorder and (b) avoidance behavior moderated this relationship in women with a specific phobia but not in women with a social anxiety disorder. Specifically, high avoidance behavior was found to amplify the effect between general anxiety at baseline and follow-up in specific phobia. Reasons for the absence of a similar moderating effect of avoidance behavior within social anxiety disorder are discussed.

Experience with Dental Pain and Fear of Dental Pain

Anxious people tend to overestimate the intensity of aversive events such as fear and pain. When an aversive event has been experienced personally, prediction is based on experience and is possibly less subject to bias due to anxiety. Therefore, it was hypothesized that subjects will overestimate fear of specific dental pains relative to subjects who experienced the pain or procedure personally. Samples of highly anxious dental patients (n = 48), patients waiting for periodontal treatment (n = 56), and psychology freshmen (n = 262) completed a measure of dental anxiety and the Fear of Dental Pain (FDP) questionnaire. All FDP items were extended with the question whether the subject ever experienced the pain personally (yes or no). Less fear was reported when the pain had been experienced personally, with the exception of the sample of highly anxious dental patients. The results suggest that fear of dental pain is a highly important covariate in dental pain research.

Disrupted Prediction Error Links Excessive Amygdala Activation to Excessive Fear

Basolateral amygdala (BLA) is critical for fear learning, and its heightened activation is widely thought to underpin a variety of anxiety disorders. Here we used chemogenetic techniques in rats to study the consequences of heightened BLA activation for fear learning and memory, and to specifically identify a mechanism linking increased activity of BLA glutamatergic neurons to aberrant fear. We expressed the excitatory hM3Dq DREADD in rat BLA glutamatergic neurons and showed that CNO acted selectively to increase their activity, depolarizing these neurons and increasing their firing rates. This chemogenetic excitation of BLA glutamatergic neurons had no effect on the acquisition of simple fear learning, regardless of whether this learning led to a weak or strong fear memory. However, in an associative blocking task, chemogenetic excitation of BLA glutamatergic neurons yielded significant learning to a blocked conditioned stimulus, which otherwise should not have been learned about. Moreover, in an overexpectation task, chemogenetic manipulation of BLA glutamatergic neurons prevented use of negative prediction error to reduce fear learning, leading to significant impairments in fear inhibition. These effects were not attributable to the chemogenetic manipulation enhancing arousal, increasing asymptotic levels of fear learning or fear memory consolidation. Instead, chemogenetic excitation of BLA glutamatergic neurons disrupted use of prediction error to regulate fear learning.

SIGNIFICANCE STATEMENT

Several neuropsychiatric disorders are characterized by heightened activation of the amygdala. This heightened activation has been hypothesized to underlie increased emotional reactivity, fear over generalization, and deficits in fear inhibition. Yet the mechanisms linking heightened amygdala activation to heightened emotional learning are elusive. Here we combined chemogenetic excitation of rat basolateral amygdala glutamatergic neurons with a variety of behavioral approaches to show that, although simple fear learning is unaffected, the use of prediction error to regulate this learning is profoundly disrupted, leading to formation of inappropriate fear associations and impaired fear inhibition.

Exposure and response prevention process predicts treatment outcome in youth with OCD

Recent research on the treatment of adults with anxiety disorders suggests that aspects of the in-session exposure therapy process are relevant to clinical outcomes. However, few comprehensive studies have been conducted with children and adolescents. In the present study, 35 youth diagnosed with primary obsessive-compulsive disorder (OCD; M age = 12.9 years, 49% male, 63% Caucasian) completed 12 sessions of exposure and response prevention (ERP) in one of two treatment conditions as part of a pilot randomized controlled testing of a family focused intervention for OCD. Key exposure process variables, including youth self-reported distress during ERP and the quantity and quality of ERP completed, were computed. These variables were examined as predictors of treatment outcomes assessed at mid-treatment, post-treatment, and three-month follow-up, partialing treatment condition. In general, greater variability of distress during ERP and completing a greater proportion of combined exposures (i.e., exposures targeting more than one OC symptom at once) were predictive of better outcomes. Conversely, greater distress at the end of treatment was generally predictive of poorer outcomes. Finally, several variables, including within- and between-session decreases in distress during ERP, were not consistently predictive of outcomes. Findings signal potentially important facets of exposure for youth with OCD and have implications for treatment. A number of results also parallel recent findings in the adult literature, suggesting that there may be some continuity in exposure processes from child to adult development. Future work should examine additional measures of exposure process, such as psychophysiological arousal during exposure, in youth.

Know Thyself

Self-knowledge has never been a central topic; in empirical psychology. There are pockets of research on self-knowledge in different subdisciplines of the field, but until now there has been little communication between them. I believe that these areas will converge in the next few years into a cohesive study of how people form judgments about their past, current, and future selves and about the accuracy of these judgments. I discuss theoretical developments in this area, the costs of poor self-knowledge, how people can know themselves better, and some of the obstacles to the study of self-knowledge.

Pharmacogenetic excitation of dorsomedial prefrontal cortex restores fear prediction error

Pavlovian conditioning involves encoding the predictive relationship between a conditioned stimulus (CS) and an unconditioned stimulus, so that synaptic plasticity and learning is instructed by prediction error. Here we used pharmacogenetic techniques to show a causal relation between activity of rat dorsomedial prefrontal cortex (dmPFC) neurons and fear prediction error. We expressed the excitatory hM3Dq designer receptor exclusively activated by a designer drug (DREADD) in dmPFC and isolated actions of prediction error by using an associative blocking design. Rats were trained to fear the visual CS (CSA) in stage I via pairings with footshock. Then in stage II, rats received compound presentations of visual CSA and auditory CS (CSB) with footshock. This prior fear conditioning of CSA reduced the prediction error during stage II to block fear learning to CSB. The group of rats that received AAV-hSYN-eYFP vector that was treated with clozapine-N-oxide (CNO; 3 mg/kg, i.p.) before stage II showed blocking when tested in the absence of CNO the next day. In contrast, the groups that received AAV-hSYN-hM3Dq and AAV-CaMKIIα-hM3Dq that were treated with CNO before stage II training did not show blocking; learning toward CSB was restored. This restoration of prediction error and fear learning was specific to the injection of CNO because groups that received AAV-hSYN-hM3Dq and AAV-CaMKIIα-hM3Dq that were injected with vehicle before stage II training did show blocking. These effects were not attributable to the DREADD manipulation enhancing learning or arousal, increasing fear memory strength or asymptotic levels of fear learning, or altering fear memory retrieval. Together, these results identify a causal role for dmPFC in a signature of adaptive behavior: using the past to predict future danger and learning from errors in these predictions.

Behavioral and experiential avoidance in patients with hoarding disorder

BACKGROUND AND OBJECTIVES

This study examined the relationship between experiential and behavioral avoidance and hoarding symptom severity, controlling for anxiety and depression symptoms, in 66 adult individuals (M age = 61.41; SD = 9.03) with HD.

METHODS

Hierarchical regression was used to test the associations between hoarding severity, as defined by the Savings Inventory-Revised (SI-R) total and its three subscales, and avoidance, as defined by the Acceptance and Action Questionnaire II (AAQ-II) and two scales from the Brief COPE (Self-Distraction and Behavioral Disengagement) when controlling for anxiety and depression symptoms.

RESULTS

Experiential avoidance (AAQ-II) and behavioral avoidance (Brief COPE subscales Self-Distraction and Behavioral Disengagement) uniquely accounted for aspects of hoarding severity (SI-R) in regression models. Behavioral avoidance contributed significant additional variance to the SI-R Clutter subscale, whereas experiential avoidance was uniquely predictive of additional variance in the SI-R Difficulty Discarding and the SI-R Acquisition subscales.

LIMITATIONS

Future research should examine the effect of experiential avoidance on hoarding behaviors experimentally.

CONCLUSIONS

Given that the AAQ-II and Self-Distraction and Behavioral Disengagement subscales were not correlated, these findings suggest that experiential and behavioral avoidance are two distinct processes contributing to the severity of specific HD. Results support the utility of avoidance in the cognitive-behavioral model for HD.

Beliefs about control and the persistence of cleaning behaviour: an experimental analysis

BACKGROUND AND OBJECTIVES

Low perceived control (PC) and overestimations of controllability have each been related to obsessive compulsive (OC) symptoms and behaviour. OC beliefs and symptoms are also associated with a discrepancy between low perceived control (PC) and a high desire for control (DC). The present study sought to examine the influence of components of PC, low control-related self-efficacy (CSE) and high predicted controllability (PRC), on the persistence of cleaning behaviour and DC ratings.

METHODS

A cleaning task was used to observe cleaning time (in seconds) in undergraduate participants (n = 174) under two conditions of each of PRC (high versus low), and CSE (high versus low). DC ratings were taken prior to the cleaning task.

RESULTS

It was demonstrated that PRC and CSE manipulations had differential effects on cleaning times and DC ratings, where significantly longer cleaning times were observed in the high (versus low) PRC condition, and in association with higher DC ratings reported in the low (versus high) CSE condition. However, regression analyses demonstrated that DC, PRC and CSE each accounted for significant variance in observed cleaning times.

LIMITATIONS

Teasing apart predictability from controllability is a methodological challenge in the manipulation of perceived control.

CONCLUSIONS

Findings highlight the importance of considering components of PC along with DC in OC-phenomenology; these will be discussed in the context of current cognitive theories of and treatments for OCD.

Measuring dental fear using the CFSS-DS. Do children and parents agree?

BACKGROUND

In most studies, the parental version of the CFSS-DS is used; however, no information is available concerning the extent to which parents are able to report dental fear on behalf of their children.

AIM

This study aims to assess whether parents are accurate reporters of their child's dental fear.

METHODS

The CFSS-DS was filled out by 326 children in a classroom setting and by 167 parents (mostly mothers) at home on behalf of their child. Intraclass correlation coefficients were used as a measure of agreement between both CFSS-DS versions, and reasons for nonagreement were assessed.

RESULTS

Mean CFSS-DS for children was 21.15 (SD = 6.4) and for parents 23.26 (SD = 6.7). The intraclass correlation coefficient was 0.57. After selection of the 73.1% most accurate reporting parents, the ICC was 0.90. In general, parents estimate the dental fear of their children higher than their children do (P ≤ 0.001), whereas parents of high anxious children (HAC) estimate this fear lower, and parents of low anxious children (LAC) estimate this fear higher. Anxious parents (AP) estimate the dental fear of their children significantly higher than nonanxious parents (NAP) (P ≤ 0.001), but the children of AP do not estimate their own dental fear higher than children of NAP.

CONCLUSIONS

In general, parents tend to estimate the dental fear of their children slightly higher than their children.

The role of neuroimaging for the diagnosis and treatment of anxiety disorders

Neuroimaging comprises a set of tools, which include different types of magnetic resonance imaging such as functional magnetic resonance imaging (fMRI), Magnetic Resonance Spectroscopy (MRS), Arterial Spin Labeling (ASL), and radiotracer imaging such as positron emission tomography and single photon emission computed tomography. The focus of this review is to address the question whether fMRI can contribute to the diagnosis and treatment of anxiety disorders. Key anxiety processes and neural substrates are reviewed. The main findings and shortcomings of fMRI in the context of anxiety are briefly summarized. Finally, the next stages of developing fMRI for diagnosis and treatment are highlighted. The main conclusion of this review is that fMRI could become a clinical tool for the diagnosis and treatment of anxiety disorders, but neuroimaging groups will need to better develop its specificity and sensitivity so that fMRI results can be meaningful for an individual patient not just for groups of individuals.

The role of imagery in the maintenance and treatment of snake fear

Two studies assessed the role of mental imagery in the maintenance of fear of common phobic stimuli. Study 1 asked participants who were afraid of a wide range of phobic stimuli to report their visual and somatic imagery. Blind ratings of the imagery on horror and vividness were positively correlated with participant's self-reported fear and avoidance. Study 2 tested the efficacy of modifying imagery using cognitive restructuring compared to in vivo exposure and a minimal exposure, relaxation control in snake fearful participants. Both active treatment groups improved significantly more than the control group in self-reported snake fearfulness and behavioral approach. Condition also interacted with initial severity. Highly fearful subjects responded better to the cognitive imagery modification than to the in vivo exposure, and found the cognitive intervention significantly less aversive. These results are seen as supporting a cognitive model of the maintenance of specific phobia.

Predicting preferences: a neglected aspect of shared decision-making

In recent years, shared decision-making between patients and doctors regarding choice of treatment has become an issue of priority. Although patients' preferences lie at the core of the literature on shared decision-making, there has not been any attempt so far to link the concept of shared decision-making with the extensive behavioural literature on people's self-predictions of their future preferences. The aim of the present review is to provide this link. First, we summarize behavioural research that suggests that people mispredict their future preferences and feelings. Secondly, we provide the main psychological accounts for people's mispredictions. Thirdly, we suggest three main empirical questions for inclusion in a programme aimed at enriching our understanding of shared decision-making and improving the procedures used for putting it into practice.

Long term consequences of suppression of intrusive anxious thoughts and repressive coping

The current experiment employed a thought suppression paradigm to investigate whether repressors (N=40) are more skilled in suppressing positive and anxious autobiographical thoughts than low anxious (N=40), high anxious (N=40), and defensive high anxious (N=40) individuals, both immediately and over a longer time period (i.e., 7 days). Regardless of suppression instructions, repressors reported during their lab visit fewer target thoughts for their most anxious events than participants in the other three groups. However, over a 7 days period, repressors showed the highest number of intrusive thoughts about their anxious autobiographical events. Thus, our results demonstrate that repressive coping might be adaptive in the short run, but counterproductive in the long run.

Reduction of pain-related fear in complex regional pain syndrome type I: the application of graded exposure in vivo

Fear of (re)injury/movement has been identified as a potential predictor of chronic disability in complex regional pain syndrome type I (CRPS-I). In order to reduce pain-related fears and pain disability, graded exposure in vivo (GEXP) is likely to be an appropriate treatment. Indeed, there is evidence that in chronic pain patients reporting substantial fear of (re)injury/movement, GEXP is successful in reducing pain disability. However, the efficacy of exposure-based protocols in the treatment of CRPS-I patients for reducing pain disability has not been tested. The main research question of this study was whether the reduction of pain-related fear through GEXP also resulted in a decrease of disability in a subgroup of patients with CRPS-I who report substantial pain-related fear. A single-case experimental ABCD-design was used with random determination of the start of the intervention. Eight patients with CRPS-I were included in the study. To assess daily changes in pain intensity, pain-related fear, pain catastrophizing, and activity goal achievement, a diary was used. Standardized questionnaires of pain-related fear, pain disability, and self-reported signs and symptoms of CRPS-I were administered before and after each intervention, and at 6-month follow-up. The current study supports a GEXP approach to chronic CRPS-I. The GEXP was successful in decreasing levels of self-reported pain-related fear, pain intensity, disability, and physiological signs and symptoms. These results support the hypothesis that the meaning people attach to a noxious stimulus influences its experienced painfulness, and that GEXP activates cortical networks and reconciles motor output and sensory feedback.

The match-mismatch model and panic patients' accuracy in predicting naturally occurring panic attacks

The match-mismatch model of panic states that panic disorder patients tend to overestimate the probability of panic prior to engaging in a fear-provoking situation. Furthermore, patients are expected to become more accurate in predicting panic over subsequent occasions of exposure. We tested the model with naturally occurring panic attacks. Patients rated the probability of a panic attack in the morning, and these ratings were compared to the actual occurrence of panic that day. Ratings were collected daily in a baseline period before treatment, during treatment, and again for 2 weeks after treatment. The results confirmed that panic disorder patients tend to overpredict the likelihood of panic. However, patients did not become more accurate in their predictions over time. In fact, overprediction bias increased because expectancy of panic remained stable, in spite of the decline of the frequency of panic from pre- to post-test. Thus, over a short course of therapy panic patients tend to persist in overestimating the chance that panic may occur. At baseline, expectancy of panic and the tendency to overpredict were not associated with other aspects of the symptomatology. Neither expectancy nor overprediction bias was predictive of treatment outcome. Finally, improvement in treatment was not associated with a decreased expectancy of panic.

Pain anxiety among chronic pain patients: specific phobia or manifestation of anxiety sensitivity?

Rather than viewing anxiety among chronic pain patients as simply a component of negative affectivity, investigators have developed a model of "pain anxiety" in which patients develop fear and avoidance of activity linked to pain. We examined whether pain anxiety can be conceptualized as a specific phobia, or whether evidence supported the notion that pain anxiety is better understood as a manifestation of anxiety sensitivity in the context of chronic pain. Chronic musculoskeletal pain patients (N=70) underwent cold pressor and mental arithmetic tasks while cardiovascular, self-report, and behavior indexes were recorded. They completed measures of pain anxiety, anxiety sensitivity, fear of negative evaluation, depression and trait anxiety. Correlation analyses showed pain anxiety was related to pain-relevant responses during cold pressor, but it was also related to evaluation-relevant responses during cold pressor, and to pain- and evaluation-relevant responses (including subtraction accuracy) during mental arithmetic. Regression analyses showed that almost all effects of pain anxiety on task responses were accounted for by anxiety sensitivity. Fear of negative evaluation, in contrast, correlated only with evaluation-relevant responses, and mostly during mental arithmetic. These effects remained significant when depression, trait anxiety, or anxiety sensitivity were statistically controlled. Pain anxiety may be an expression of anxiety sensitivity rather than a circumscribed phobia; a distinction that could profitably guide treatment strategies.

Panic termination and the post-panic period

A comprehensive theory of panic must explain not only the cause(s) of episodes of panic but also why and when panic episodes terminate. Accordingly, we conducted a set of three studies on participants with panic disorder in order to investigate these aspects of panic episodes. In Study 1, we asked participants to monitor their panics prospectively, paying particular attention to the episodes' conclusions and the time period which followed. Results from Study 1 were consistent with earlier retrospective studies, showing that people engage in safety and other behaviors in an attempt to end their panics. We also collected information from the participants on beliefs about panic termination and the post-panic period. Study 2 was designed to determine if a post-panic refractory period occurs. Participants were asked to complete a hyperventilation exercise, and then to repeat the exercise a second time. Results from this study provide scant evidence of a post-panic refractory period. Study 3 was a more ecologically valid version of Study 2, in which participants were asked to re-trigger panics that occurred in their natural surroundings. Again, there was little support for a post-panic refractory period. Results are discussed in terms of cognitive-behavioral and biological theories of panic disorder.

Response to repeated CO2 in individuals with elevated anxiety sensitivity: replication with 20% CO2

The present report replicates and extends previous work examining response patterns to repeated presentation of CO2. In previous studies, two distinct response patterns to repeated presentation of 35% CO2 were noted, representing habituation and nonhabituation of anxiety. In this report, 21 participants who had never experienced a panic attack but who reported high levels of anxiety sensitivity were presented with 12 trials of 20% CO2, followed by a trial involving inhalation of room air (to examine dishabituation) and two more trials of 20% CO2. Results indicated that 67% of the sample reported habituation of anxiety. Reductions in anxiety across inhalations were paralleled by changes in tidal volume, perceived panic symptom severity, and feelings of panic. Notable dishabituation was observed in the nonhabituation sample. Results are discussed in the light of basic learning processes underlying the treatment of Panic Disorder (PD).

Effects of familial pain models on daily pain indices and performance during the cold pressor task

To understand better the role of pain history in current response to pain episodes, this research examined pain-related indices from the patient's family of origin and their relationships to the patient's coping with acute pain. Participants were 42 healthy men and women who provided information about their own and their family's pain history and then were administered a cold pressor task. High frequency of family pain modeling was associated with higher frequency of current pain episodes, more types of pain, greater intensity, and also lower physiological arousal and subjective pain ratings during the cold pressor. The findings underscore the relationships between familial pain modeling and current pain-related functioning.

Beyond pain: the role of fear and avoidance in chronicity

The purpose of the present article is to provide unification to a number of somewhat disparate themes in the chronic pain and phobia literature. First, we present a summary review of the early writings and current theoretical perspectives regarding the role of avoidance in the maintenance of chronic pain. Second, we present an integrative review of recent empirical investigations of fear and avoidance in patients with chronic musculoskeletal pain, relating the findings to existing cognitive-behavioral theoretical positions. We also discuss several new and emerging lines of investigation, specifically related to information processing and anxiety sensitivity, which appear to be closely linked to pain-related avoidance behavior. Finally, we discuss the implications of the recent empirical findings for the assessment and treatment of individuals who experience disabling chronic musculoskeletal pain and suggest possible avenues for future investigation.

Cognitive analysis of unwanted intrusive thoughts and facial hair: an idea before its time?

Durac (1997, Behaviour Research and Therapy, 35, 371-372) recently attempted a cognitive analysis of unwanted intrusive thoughts and the growth of facial hair. Though provocative, there are a number of conceptual, methodological and clinical issues that are inadequately addressed by this paper. Based on a thorough reading of a relevant body of literature from 1963 to 1994, five issues are addressed in a hirsute manner: (1) the origin of the phenomenon, (2) behavioral analysis of unwanted intrusive thoughts and the growth of facial hair (UIFHG), (3) the role of behavioral exercises in the disappearance of unwanted facial hair, (4) the serotonin connection underlying this disorder, and (5) ethical concerns in the treatment of UIFHG. Finally, important theoretical and clinical implications of the cognitive model are not discussed here: they will be reported elsewhere in a more extensive analysis.

Why do people tend to overpredict pain? On the asymmetries between underpredictions and overpredictions of pain

After an underpredicted painful experience people tend to expect increased pain levels for a considerable time, despite disconfirmatory experiences. Underpredictions also tend to raise long-lasting fear and increased physiological responding. Overpredicted pain does not have such dramatic effects. What are the reasons for this asymmetry? Evidence for and against the hypothesis that underpredicted pain hurts more than correctly predicted pain, and that overpredictions result from a tendency to avoid the extra aversiveness of underpredictions, is reviewed. Based on recent experiments this explanation is rejected, and alternative explanations are discussed. It is reasoned that the most plausible explanation is that the organism automatically infers danger from an underprediction, because of the loss of predictability into the dangerous direction (i.e. more pain). Elevated expectancy and fear levels are the result of this. A modified stimulus-comparator model that accounts for the differential effects of both types of incorrect predictions is suggested. In contrast to previous models, such a model hypothesizes: (i) differential processing of under- and overpredictions; and (ii) different processes involved in the influence of expectations on subjective and non-subjective pain responses.

Stimulus estimation and the overprediction of fear: a comment on two studies

The overprediction of fear is the tendency to overestimate the amount of fear one will experience in a subjectively threatening situation. This bias is thought to promote excessive avoidance and limit the opportunity for corrective learning. The stimulus estimation model states that the overprediction of fear arises from the overprediction of the danger features of the stimulus and the underprediction of available safety resources. Two recent studies reportedly failed to support the model (Arntz, Hildebrande & van den Hout, Behaviour Research and Therapy, 32, 709-722, 1994; Telch, Valentiner & Bolte, Behaviour Research and Therapy, 32, 747-751, 1994). The present commentary shows that both studies suffered significant methodological problems and neither can be said to have tested the model. Criteria for evaluating the model are briefly discussed.