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Stavropoulos L, Cooper DDJ, Champion SM, Keevers L, Newby JM, Grisham JR. Basic processes and clinical applications of mental imagery in worry: A systematic review. Clin Psychol Rev 2024; 110:102427. [PMID: 38640775 DOI: 10.1016/j.cpr.2024.102427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/17/2023] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND In this systematic review, we aimed to synthesise existing research on the phenomenology of mental imagery among high worriers compared to healthy individuals, and to characterise the nature and effectiveness of existing imagery-related interventions in treatment of worry. METHODS PsycInfo, CENTRAL, EMBASE, Medline, Medline Epub, and PubMed were searched for studies examining the relationship between worry/GAD and mental imagery, or interventions using imagery in treatment of worry/GAD. We assessed study quality and used qualitative narrative synthesis to comprehensively map study results. RESULTS The search yielded 2589 abstracts that were assessed for eligibility independently by two authors. From this, 183 full texts were screened and 50 qualitatively synthesised. Twenty-seven reported an association between worry/GAD and an aspect of mental imagery. Here, overactive negative and worry imagery, and diminished positive future imagining, were associated with worry/GAD. Twenty-three studies reported an intervention. This literature suggested mixed findings regarding efficacy, including for imaginal exposure as an independent technique for GAD. CONCLUSIONS Findings support dysfunctional negative imagining and diminished positive prospective imagery in GAD. General imagining abilities remain intact, which is promising for efforts to utilise imagery in treatment. Further research is warranted to develop innovative clinical applications of imagery in treatment of GAD.
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Affiliation(s)
- Lauren Stavropoulos
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.
| | - David D J Cooper
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Sophie M Champion
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Luke Keevers
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia; Black Dog Institute, UNSW, Hospital Road, Randwick, Sydney 2022, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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Benke C, Wallenfels LM, Bleichhardt GM, Melzig CA. Health anxiety amplifies fearful responses to illness-related imagery. Sci Rep 2024; 14:4345. [PMID: 38388793 PMCID: PMC10883981 DOI: 10.1038/s41598-024-54985-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 02/24/2024] Open
Abstract
Severe health anxiety (HA) is characterized by excessive worry and anxiety about one's health, often accompanied by distressing intrusive imagery of signs of a serious illness or potentially receiving bad news about having a life-threatening disease. However, the emotional responses to these illness-related mental images in relation to HA have not been fully elucidated. Emotional responses to mental imagery of 142 participants were assessed in a well-controlled script-driven imagery task, systematically comparing emotional responses to illness-related imagery with neutral and standard fear imagery. The results revealed that participants reported higher anxiety, aversion, emotional arousal, and a stronger avoidance tendency during imagery of fear and illness-related scenes compared to neutral scenes. Importantly, the emotional modulation varied by the level of HA, indicating that individuals with higher HA experienced stronger emotional responses to illness-related imagery. This association between HA and fearful imagery could not be better accounted for by other psychological factors such as trait anxiety, anxiety sensitivity, somatic symptom severity, or symptoms of depression and anxiety. Fearful responding to standard threat material was not associated with HA. The present findings highlight the importance of considering fear responding to mental imagery in understanding and addressing HA.
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Affiliation(s)
- Christoph Benke
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Laura-Marie Wallenfels
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Gaby M Bleichhardt
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Christiane A Melzig
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
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Khan N, Iqra Tanveer Khan S, Joti S, Malik J, Faraz M, Ashraf A. Association of Cardiovascular Diseases With Post-Traumatic Stress Disorder: An Updated Review. Cardiol Rev 2023:00045415-990000000-00174. [PMID: 37966219 DOI: 10.1097/crd.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The intricate relationship between post-traumatic stress disorder (PTSD) and cardiovascular disease (CVD) has garnered increasing attention due to its bidirectional impact and potential for significant health consequences. Epidemiological evidence suggests that PTSD may serve as a risk factor for incident CVD, while acute CVD events can trigger PTSD, subsequently increasing the risk of recurrent cardiovascular events. This dynamic interplay is characterized by the human stress response, disrupted behavioral and lifestyle factors, and potential physiological mechanisms. Notably, the immediate aftermath of a cardiovascular event presents a critical window for intervention, offering the possibility of preventing the development of PTSD and its associated physiological and behavioral sequelae. However, while candidate mechanisms linking PTSD and CVD have been identified, determining which mechanisms are most amenable to intervention remains a challenge. This article emphasizes the urgency of addressing key unanswered questions in this domain. Despite an evolving understanding of the association between PTSD and CVD, causal relationships remain to be firmly established. Comprehensive investigations into the intricate interplay of behavioral and biological mechanisms are essential for identifying precise targets for intervention. Innovations in research methodologies, including the exploration of PTSD symptom dynamics and their impact on cardiovascular function, hold the potential for identifying crucial intervention points. Drawing parallels from prior challenges in translating identified risk factors into effective interventions, the field must prioritize systematic investigations and early-phase intervention trials. By doing so, researchers and clinicians can potentially develop strategies to mitigate CVD risk in the context of PTSD and improve both cardiovascular and mental health outcomes.
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Affiliation(s)
- Naqeeb Khan
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
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Lamba N, Khokhlova O, Bhatia A, McHugh C. Mental health hygiene during a health crisis: Exploring factors associated with media-induced secondary trauma in relation to the COVID-19 pandemic. Health Psychol Open 2023; 10:20551029231199578. [PMID: 37746585 PMCID: PMC10517610 DOI: 10.1177/20551029231199578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Aims Given the risk of developing vicarious trauma through news media has increased during the pandemic, we explored risk factors associated with media induced secondary trauma, and its behavioral and psychological implications. Methods An international study (N = 1066), with a diverse sample, was administered in July 2020. We used standardized and validated questionnaires to measure news consumption, media-related trauma, compliance, and paranoia. Results Greater frequency of news consumption, accessing news via social media and WHO, and believing in conspiracy theories increased likelihood of developing media-induced secondary trauma. News related trauma was associated with greater compliance with safety measures and increased paranoid ideation. Media-trauma however exhibited a greater association with paranoia than compliance. Conclusion Findings highlight the need to facilitate a collaborative intervention, with public, media houses, health safety officials, and social scientists to have a deeper understanding of potential psychological costs of news consumption patterns.
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Affiliation(s)
- Nishtha Lamba
- Department of Psychology, Middlesex University Dubai, Dubai, UAE
| | - Olga Khokhlova
- Department of Psychology, Middlesex University Dubai, Dubai, UAE
| | - Aditi Bhatia
- Department of Psychology, Middlesex University Dubai, Dubai, UAE
| | - Cillian McHugh
- Department of Psychology, University of Limerick, Limerick, Ireland
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Validity and clinical utility of distinguishing between DSM-5 somatic symptom disorder and illness anxiety disorder in pathological health anxiety: Should we close the chapter? J Psychosom Res 2023; 165:111133. [PMID: 36624001 DOI: 10.1016/j.jpsychores.2022.111133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the validity and clinical utility of distinguishing between DSM-5 somatic symptom disorder (SSD) and illness anxiety disorder (IAD) in pathological health anxiety: the excessive and recurrent fear of, or preoccupation with, having or developing a serious health condition. METHODS We compared SSD to IAD in pathological health anxiety (N = 334) with regard to concurrent, antecedent, and predictive validators. This was primarily a cross-sectional study, though we studied the effect of CBT longitudinally. Because we were interested in the discriminatory value of SSD and IAD over and above trait health anxiety, we used trait health anxiety as a covariate. RESULTS SSD (68%; 228/334) vs. IAD (32%; 106/334) differences were mostly non-significant and small in sociodemographics, core clinical characteristics, apparent course, etiological attribution, and physician visits (gs = -0.18-0.20; RRs = 0.84-1.09; IRRs = 0.87-0.99). However, SSD was associated with a significantly higher somatic symptom burden (gs = 0.20-0.72), more psychologist visits (IRR = 2.02, 95% CI: 1.24-3.28), and slightly higher disability (g = 0.22, 95% CI: 0.03-0.42). There was no significant difference in symptom reduction during CBT (g = -0.16, 95% CI: -0.37-0.05). CONCLUSION Although not all differences between SSD and IAD in pathological health anxiety seem to be explained by the level of trait health anxiety, the SSD vs. IAD distinction appears to convey little useful information in pathological health anxiety. Tentatively, considering the well-documented clinical characteristics and effective clinical interventions, it is probably most helpful to regard pathological health anxiety as a de facto anxiety or perhaps obsessive-compulsive spectrum disorder, regardless of the DSM-5 diagnosis of SSD or IAD.
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Thunnissen MR, Nauta MH, de Jong PJ, Rijkeboer MM, Voncken MJ. Flashforward imagery in speech anxiety: Characteristics and associations with anxiety and avoidance. Front Psychol 2022; 13:975374. [PMID: 36267078 PMCID: PMC9577331 DOI: 10.3389/fpsyg.2022.975374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Speech anxiety (SA) is a highly prevalent social fear. Prospective ‘flashforward’ (FF) imagery of an upcoming social catastrophe may be a particularly important cognitive factor in SA persistence via eliciting anxiety and avoidance behaviors. Since earlier research on imagery and social anxiety has not strictly differentiated between types of negative imagery, the occurrence, precise features, and impact of FF imagery remain unclear. We therefore examined the phenomenological characteristics of FF imagery in SA and mapped the relationship between FF imagery features and anxiety and avoidance. Female participants who approached clinical levels of SA (N = 60) completed questionnaires on SA and avoidance behaviors, and rated anxiety and avoidance in anticipation of an actual speech. FF imagery and emotionally linked autobiographical memories were assessed with semi-structured interviews. All participants reported recurring FF images, which were experienced as vivid, distressing, field perspective images with accompanying negative feelings. Image distress and feelings of threat showed most consistent associations with SA and avoidance measures. Findings add to the conceptualization of SA, and support the clinical relevance of assessing FF imagery. Future experimental studies on FF imagery characteristics are necessary to test the proposed causal impact in SA persistence and to inform additional treatment targets.
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Affiliation(s)
- Marjolein R. Thunnissen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
- Accare, University Center for Child and Adolescent Psychiatry, Groningen, Netherlands
- *Correspondence: Marjolein R. Thunnissen,
| | - Maaike H. Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Peter J. de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Marleen M. Rijkeboer
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Marisol J. Voncken
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
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Barbek R, Henning S, Ludwig J, von dem Knesebeck O. Ethnic and migration-related inequalities in health anxiety: A systematic review and meta-analysis. Front Psychol 2022; 13:960256. [PMID: 36092037 PMCID: PMC9462455 DOI: 10.3389/fpsyg.2022.960256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Health anxiety exists on a continuum ranging from the absence of health awareness to the obsessive fear of having a serious illness despite reassurance. Its pathological manifestation can be diagnosed as hypochondriacal or illness anxiety or somatic symptom disorder. Health anxiety is associated with psychological distress and adverse life events, among others, and leads to considerable economic burden. Compared to the majority population, migrants, and ethnic minorities often face major health inequalities. Several mental illnesses and psychosomatic complaints are more common among these groups. To date, potential ethnic and migration-related inequalities in health anxiety have not been clearly described. However, they are of high relevance for the provision of adequate health care of this diverse and potentially vulnerable group. Thus, we conducted a systematic review and meta-analysis of health anxiety in migrants and ethnic minorities. Methods A systematic literature search of PubMED, Web of Science, PsycINFO, and PSYNDEX was conducted, covering all studies published until 1st of December 2021. Studies were selected if they employed validated measurement tools of health anxiety and examined migrants and/or ethnic minorities in comparison with the majority population. Meta-analytic methods were applied by using a random-effect model. The study quality was assessed with the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). Results We identified 18 studies from 445 studies initially screened. Of these, 14 studies conducted in North America with a total number of 5,082 study participants were included in the meta-analysis. The pooled effect size indicated a higher risk of health anxiety in migrants and ethnic minorities compared to the majority population (OR 1.39, 95%-CI 1.01-1.92). The results proved not to be robust according to publication bias (adjusted OR 1.18, 95%-CI 0.83-1.69) and fail-safe N (2/3 < benchmark N = 75) and are limited due to heterogeneity (I 2 = 57%), small sample sizes and an overall low quality of included studies. Conclusion To address the diversity of migrants and ethnic minorities, inter-sectional approaches across different countries are needed in research to shed further light on social inequalities in health anxiety linked to migration. Systematic review registration PROSPERO, registration number CRD42022298458.
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Affiliation(s)
- Rieke Barbek
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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He Q, Chen Z, Xie C, Liu L, Yang H, Wei R. Relationship Between Dry Eye Disease and Emotional Disorder: The Mediating Effect of Health Anxiety. Front Public Health 2022; 10:771554. [PMID: 35296049 PMCID: PMC8918502 DOI: 10.3389/fpubh.2022.771554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aims to investigate the relationship between dry eye disease (DED) and anxiety, as well as DED and depression. Additionally, the influence of health anxiety (HA) on this relationship was determined.MethodsA total of 206 patients with DED were recruited from Tianjin Medical University Eye Hospital clinic and surveyed using demographic questionnaires, the Ocular Surface Disease Index (OSDI), Hospital Anxiety and Depression Scale (HADS), and Short Health Anxiety Inventory (SHAI). Additionally, they were examined using Keratograph 5M and assessed for DED by corneal fluorescein staining. Regression analysis and the bootstrap method were used to investigate the influence of HA on the relationship between DED and emotional disorders.ResultsAmong the 206 patients with DED, 52 (25.24%) and 56 (27.18%) patients showed depression and anxiety, respectively. The OSDI score and HA were positively correlated with depression and anxiety (P < 0.01). The direct effects of OSDI on depression and anxiety were significant (95% confidence interval [CI]: 0.017–0.069; 0.008–0.060). Additionally, the bootstrap test showed significant mediating effects of HA (95% CI: 0.001–0.016; 0.003–0.021). The results suggested that the severity of DED symptoms, as measured by the OSDI score, affected anxiety and depression by a direct and an indirect pathway mediated by HA.ConclusionsWe found a significant correlation between DED and anxiety and depression. Moreover, HA was a mediator of the relationship between DED symptoms and anxiety and depression.
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Affiliation(s)
- Qing He
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Zhuo Chen
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Caiyuan Xie
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Lin Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Haibo Yang
- Academy of Psychology and Behavior, Tianjin Normal University, Tianjin Social Science Laboratory of Students' Mental Development and Learning, Tianjin, China
| | - Ruihua Wei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
- *Correspondence: Ruihua Wei
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Benke C, Schönborn T, Habermann N, Pané-Farré CA. Health anxiety is associated with fearful imagery of contracting COVID-19: An experimental study. J Affect Disord 2022; 298:316-321. [PMID: 34763031 PMCID: PMC8574074 DOI: 10.1016/j.jad.2021.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Aversive mental images of contracting or having a severe disease are assumed to contribute to the development and maintenance of health anxiety (HA) via the elicitation of fear, arousal and defensive mobilization. The current COVID-19 pandemic is known to trigger fears of contracting COVID-19. METHODS In this study, we used an experimental approach to investigate whether COVID-19-related mental images lead to a fearful response and whether this is associated with levels of HA. 139 participants vividly imagined neutral, standard fear and COVID-19 related narrative scenes. RESULTS Standard fear and COVID-19 scripts prompted higher anxiety, arousal, displeasure and avoidance tendencies as compared to neutral scripts. HA was associated with higher anxiety, arousal, displeasure, imagery vividness and stronger avoidance tendencies during imagery of COVID-19 scenes. No associations were found for anxiety sensitivity, trait anxiety as well as depressive and anxiety symptoms. Moreover, there was no association of HA with emotional responses during imagery of standard fear scenes. LIMITATIONS Fear responses were assessed via verbal reports. Future studies should also assess behavioral and physiological correlates of fear. CONCLUSIONS The present results indicate that individuals with high levels of HA are prone to fearful mental imagery of contracting COVID-19 which might be crucial factor contributing to the exacerbation and chronicity of excessive HA in times of a pandemic.
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Affiliation(s)
- Christoph Benke
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
| | - Tabea Schönborn
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Nina Habermann
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Christiane A. Pané-Farré
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany,Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
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Nasiri M, Mohammadkhani S, Akbari M, Alilou MM. The structural model of cyberchondria based on personality traits, health-related metacognition, cognitive bias, and emotion dysregulation. Front Psychiatry 2022; 13:960055. [PMID: 36699479 PMCID: PMC9869141 DOI: 10.3389/fpsyt.2022.960055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Cyberchondria is excessive seeking for online health-related information related to increasing health anxiety and distress levels. The current study investigated the mediating role of health-related metacognition, cognitive bias, and emotion dysregulation in the relationship between personality traits and cyberchondria. METHODS Participants were 703 individuals 18+ years old who had access to the internet (males = 43.8%, mean age = 33.82 ± 10.09 years and females = 56.2%, mean age = 34.37 ± 11.16 years). They voluntarily completed a questionnaire package that included the Cyberchondria Severity Scale (CSS), the revised NEO Personality Inventory (NEO-PI-R), the Difficulties in Emotion Regulation Scale (DERS), the Meta-Cognitions about Health Questionnaire (MCQ-HA), and the Health Cognitions Questionnaire (HCQ). RESULTS The initial evaluation of the model demonstrated that the personality traits of openness to experience, agreeableness, and conscientiousness had no significant relationship with other variables in the structural model, and the effects of neuroticism and extroversion were the only significant results. Rerunning the model with the removal of non-significant variables revealed a full mediation of health-related metacognition, cognitive bias, and emotion dysregulation in the relation between personality traits (neuroticism and extraversion) and cyberchondria. Fit indices demonstrated the acceptable fit of the model with the collected data (χ2 = 979.24, p <.001; NFI = 0.92, CFI = 0.93, GFI = 0.90, IFI = 0.93, RMSEA = 0.071, and SRMR = 0.063). The results indicated that the present model could explain R 2 = 54% of cyberchondria variance. DISCUSSION These findings suggest that health-related metacognition, cognitive bias, and emotion dysregulation could demonstrate a full mediating role in the correlation between personality traits and cyberchondria.
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Affiliation(s)
- Mohammad Nasiri
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Shahram Mohammadkhani
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Majid Mahmoud Alilou
- Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tabriz, Tabriz, Iran
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Coloma-Carmona A, Carballo JL. Predicting PTSS in general population during COVID-19 pandemic: The mediating role of health anxiety. J Affect Disord 2021; 294:329-336. [PMID: 34311333 PMCID: PMC8302506 DOI: 10.1016/j.jad.2021.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/14/2021] [Accepted: 07/10/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite health anxiety (HA) is associated with higher incidence of anxiety disorders, no studies have examined the association between this variable and the increased levels of Post-Traumatic Stress Symptoms (PTSS) reported during COVID pandemic. METHODS This study was conducted online between April and May 2020. Data were collected from 468 men and women from the Spanish general population. Sociodemographic and COVID-19-related data, health anxiety, PTSS, fear of becoming infected, social support, sleep problems and past/current psychological/psychiatric history were assessed. The mediating effect of HA when predicting PTSS was explored with mediational analyses. Moderated mediational analyses were also performed to test if receiving psychological treatment during pandemic changes the mediating effect of HA. RESULTS Prevalence of PTSS was higher in high-scorers in HA (p<.01). High HA was also more likely to be reported by women, individuals with sleep problems, frequently fear of getting infected, and those who have previously received psychological treatment (p<.01). HA mediates the relationship between PTSS and the following predictors of PTSS: sleep problems, psychiatric history and fear of getting infected. Being under psychological treatment did not moderate the mediating effect of health anxiety. LIMITATIONS Further longitudinal studies with bigger sample sizes are needed to examine the causal relationship between HA and PTSS after COVID-19 pandemic. CONCLUSIONS Our findings suggest that HA could influence the psychological consequences of the pandemic. Screening of HA could be useful to identify people with heightened risk of developing PTSS during pandemic.
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Affiliation(s)
- Ainhoa Coloma-Carmona
- Center for Applied Psychology, Department of Health Psychology, Miguel Hernández University, Avenida Universidad s/n, Elche 03202, Spain.
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Pascual-Vera B, Akin B, Belloch A, Bottesi G, Clark DA, Doron G, Fernández-Alvarez H, Ghisi M, Gómez B, Inozu M, Jiménez-Ros A, Moulding R, Ruiz MA, Shams G, Sica C. Maladaptive Consequences of Mental Intrusions with Obsessive, Dysmorphic, Hypochondriac, and Eating-disorders Related Contents: Cross-cultural Differences. Int J Clin Health Psychol 2021; 22:100275. [PMID: 34703466 PMCID: PMC8517547 DOI: 10.1016/j.ijchp.2021.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/10/2021] [Indexed: 11/07/2022] Open
Abstract
Background/Objective Unwanted mental intrusions (UMIs) with contents related to Obsessive-Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), Illness Anxiety Disorder (IAD), and Eating Disorders (EDs) are highly prevalent, independently of the cultural and/or social context. Cognitive-behavioral explanations for these disorders postulates that the escalation from common UMIs to clinically relevant symptoms depends on the maladaptive consequences (i.e., emotions, appraisals, and control strategies) of experiencing UMIs. This study examines, from a cross-cultural perspective, the cognitive-behavioral postulates of the maladaptive consequences of having UMIs. Method Non-clinical 1,473 participants from Europe, the Middle-East, and South America completed the Questionnaire of Unpleasant Intrusive Thoughts to assess the maladaptive consequences of experiencing highly disturbing OCD, BDD, IAD, and EDs-related UMIs. Results Findings revealed main effects for both the country and the consequences associated with the four UMI contents. Interaction effects between the consequences of each UMI content and the sample location were also observed. Conclusions Cognitive-Behavioral models for OCD, BDD, IAD, and EDs should be implemented along with socio-cultural variables that increase the understanding of the role of these variables in the phenomenology of UMIs and their associated consequences.
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Affiliation(s)
- Belén Pascual-Vera
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad Nacional de Educación a Distancia (UNED), Spain
| | - Burcin Akin
- Department of Psychology, Başkent University, Ankara, Turkey
| | - Amparo Belloch
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Valencia, Spain
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Italy
| | - David A Clark
- Department of Psychology, University of New Brunswick, Canada
| | - Guy Doron
- Department of Psychology, Interdisciplinary Center Herzliya, Tel Aviv, Israel
| | | | - Marta Ghisi
- Department of General Psychology, University of Padova, Italy
| | | | - Mujgan Inozu
- Department of Psychology, Hacettepe University, Ankara, Turkey
| | - Antonia Jiménez-Ros
- Psychology Research Centre (CIP/UAL) & Universidade do Algarve, Faro, Portugal
| | - Richard Moulding
- Department of Psychology, Deakin University, Melbourne, Australia
| | - M Angeles Ruiz
- Universidad Nacional de Educación a Distancia UNED, Madrid, Spain
| | - Giti Shams
- Department of Psychiatry, Tehran University of Medical Science, Roozbeh Hospital, Tehran, Iran
| | - Claudio Sica
- Department of Human Health Science, University of Firenze, Italy
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Pascual-Vera B, Belloch A. Dysmorphic and illness anxiety-related unwanted intrusive thoughts in individuals with obsessive-compulsive disorder. Clin Psychol Psychother 2021; 29:313-327. [PMID: 34169614 DOI: 10.1002/cpp.2636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/18/2021] [Accepted: 06/15/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVE Unwanted intrusive thoughts (UITs) are considered normal variants of the obsessions found in obsessive-compulsive disorder (OCD). Similarly, intrusive and persistent preoccupations about appearance defects in body dysmorphic disorder (BDD) and images and thoughts about illness in illness anxiety disorder (IAD) are abnormal variants of the thoughts and concerns about appearance and health found in non-clinical individuals. This study examines whether patients with OCD have frequent and distressing UITs with contents related to BDD and IAD, in addition to OCD-related UITs. METHOD Thirty-nine participants with OCD (Mage = 32.45, standard deviation [SD] = 11.57; 63% men) completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT), designed to assess obsessional, dysmorphic and illness anxiety UITs and their associated functional consequences (emotions, appraisals, and neutralizing or control strategies). RESULTS Up to 71% of the individuals with OCD experienced the three UIT modalities. As expected, OCD-related UITs were the most frequent, although were no differences among the three UIT contents in terms of the disturbance they caused. The OCD intrusions were the most interfering, egodystonic and dysfunctionally appraised, and they instigated more neutralizing behaviours. Nonetheless, all UITs instigate the need to do something to alleviate the discomfort caused by their intrusion and attempts to suppress them. CONCLUSION UITs with different contents not always related to typical obsessive themes are a common experience in patients with OCD. These UITs could have detrimental consequences for the course of the disorder itself, and they should be adequately addressed in both the assessment and treatment of these patients.
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Affiliation(s)
- Belén Pascual-Vera
- Department of Personality Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain.,Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders (I'TOC), University of Valencia, Valencia, Spain
| | - Amparo Belloch
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders (I'TOC), University of Valencia, Valencia, Spain
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Çili S, Stopa L. A taxonomy of intrusive mental images in clinical disorders: what can "non-veridical" images tell us about the nature of human memory? Memory 2021; 30:60-66. [PMID: 33998361 DOI: 10.1080/09658211.2021.1910311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Intrusive mental images associated with autobiographical memories or depicting imagined scenes are common in psychological disorders. Although there is a growing body of literature on their contribution to psychopathology and their role in therapy, to date there have been limited attempts to categorise the different types of images that patients experience. In this article, we present a taxonomy which ranges from veridical to non-veridical intrusive images. We highlight the fact that many types of images consist of a blend of veridical and imagined details. After presenting some of the main explanations for the existence of blended and non-veridical images, we reflect on what the evidence on the content and origin of intrusive images tells us about the nature of human memory. We argue that it supports the idea of memory being constructive and briefly discuss what this means for clinical and non-clinical settings in which intrusive images have to be evaluated and used.
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Affiliation(s)
- Soljana Çili
- London College of Fashion, University of the Arts London, London, UK.,School of Psychology, University of Southampton, Southampton, UK
| | - Lusia Stopa
- School of Psychology, University of Southampton, Southampton, UK
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15
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Intrusions in test anxiety. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-0167-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Arnáez S, García-Soriano G, López-Santiago J, Belloch A. Illness-related intrusive thoughts and illness anxiety disorder. Psychol Psychother 2021; 94:63-80. [PMID: 31957211 DOI: 10.1111/papt.12267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/18/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Intrusive thoughts about health threats (illness-ITs) are a potential cognitive risk factor for the development and maintenance of illness anxiety disorder (IAD). This study analyzes the dimensionality of illness-ITs from normalcy to psychopathology, and it evaluates whether the appraisals instigated by the Its mediate between these thoughts and IAD symptoms. METHODS Two groups of individuals participated in the study and completed the Illness Intrusive Thoughts Inventory and the Whiteley Index. The first group was composed of 446 non-clinical community participants. Of them, 264 individuals (68.6% women; Mage = 30.03 [SD = 13.83]) reported having experienced an upsetting illness-IT in the past three months and were then included in the main analyses. The second group included 31 patients with a current main diagnosis of IAD based on DSM-5 criteria (51.6% women; Mage = 32.74 [SD = 9.69]). Their severity was assessed with the Hypochondriasis Yale-Brown Obsessive-Compulsive Scale -Modified version, with scores ranging from 15 to 58 (M = 46.12, SD = 9.41). RESULTS Illness-ITs are common in both non-clinical individuals and in patients with IAD, and they instigate dysfunctional emotional, cognitive, and behavioral consequences, although with greater intensity in patients than in non-clinical individuals. The relationship between illness-ITs and IAD is mediated by overestimation of threat and thought-action fusion-probability appraisals. CONCLUSION Illness-ITs are a dimensional cognitive experience. The way they are appraised facilitates their escalation into symptoms of IAD. PRACTITIONER POINTS Provides support for the cognitive explanatory model of IAD and its usefulness in clinical practice. Indicates that the way people interpret and react to naturally occurring intrusive thoughts about illness seems to be a vulnerability marker for developing an illness anxiety disorder. Emphasizes that the meaning that patients with IAD ascribe to their intrusive thoughts about illnesses must be a main target in the cognitive-behavioral treatment of IAD. Suggests that the importance of intrusive thoughts in IAD does not lie in the frequency with which they are experienced, but in the way, they are appraised/interpreted, which is what determines whether they become a clinically significant symptom. Indicates that the relationship between illness intrusive thoughts and IAD symptoms in non-clinical individuals is based on: overestimating the negative consequences of experiencing an illness intrusive thought; and the appraisal that having such a thought would increase its likelihood of coming true. Shows that the frequency of illness-related intrusive cognitions is associated with worse cognitive and behavioral consequences.
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Affiliation(s)
- Sandra Arnáez
- Department of Personality, Evaluation and Psychological Treatment, I'TOC Research Group, Universitat de València, Spain
| | - Gemma García-Soriano
- Department of Personality, Evaluation and Psychological Treatment, I'TOC Research Group, Universitat de València, Spain
| | | | - Amparo Belloch
- Department of Personality, Evaluation and Psychological Treatment, I'TOC Research Group, Universitat de València, Spain
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Abstract
Influential clinical theories propose that parts of traumatic or stressful events are stored in an unprocessed, purely perceptual form, which is inaccessible for voluntary retrieval but may spontaneously return to consciousness involuntarily in response to matching cues. This leads to perceptually vivid, and largely veridical involuntary memories of the traumatic scene, remembered with the original emotions and from the same vantage point as during the event. Several lines of evidence contradict this position. First, involuntary memories are not more veridical than memories retrieved deliberately. Second, involuntary memories for trauma-related events are not more frequently remembered with the original first-person perspective, and individuals with PTSD do not report more first-person involuntary memories than individuals without PTSD. Third, involuntary memories of stressful moments that are subjectively experienced as repetitive do not come to mind in a fixed and unchangeable form. Fourth, involuntary memories do not have privileged access to the most emotional moments (so-called hotspots) of a stressful event and the content and choice of hotspots change over time. Fourth, although involuntary memories are associated with enhanced emotional impact, this does not imply reactivation of the original emotion. We conclude that involuntary memories, although effortless, are products of (re)constructive processes.
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Affiliation(s)
- Dorthe Berntsen
- Department of Psychology and Behavioural Sciences, Center on Autobiographical Memory Research, Aarhus University, Aarhus, Denmark
| | - Niels Peter Nielsen
- Department of Psychology and Behavioural Sciences, Center on Autobiographical Memory Research, Aarhus University, Aarhus, Denmark
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18
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Imagine food, weight and shape: mental imagery in women with eating disorders compared with healthy controls. Behav Cogn Psychother 2020; 49:328-339. [PMID: 32924907 DOI: 10.1017/s135246582000065x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research into mental disorders has found mental imagery to be a maintaining factor for psychological distress. However, studies investigating mental imagery in eating disorders are scarce. AIM The aim of the present study was to compare spontaneous mental imagery related to eating, weight and/or appearance and intrusive prospective imagery in women with an eating disorder with female healthy controls. METHODS Spontaneous mental imagery and intrusive prospective imagery were assessed in adult women with an eating disorder (n = 29) and in female healthy controls (n = 32) using a semi-structured interview and the Impact of Future Events Scale, respectively. RESULTS In comparison with healthy controls, the spontaneous mental images in individuals with an eating disorder involved more sensory modalities (U = 156.50, p < .001, r = -.51), were more vivid (t (52) = 2.04, p = .047, d = .55), negative (U = 103.00, p < .001, r = -.62), and anxiety provoking (U = 158.50, p < .001, r = -.49), and were experienced with a lower sense of control (U = 215.00, p = .009, r = -.36). The emotional impact of intrusive prospective imagery (U = 105.00, p < .001, r = -.66) was also higher in individuals with an eating disorder, as was the number of negative prospective images (U = 283.00, p = .016, r = -.31). CONCLUSIONS Our findings are consistent with previous research on mental imagery in other psychiatric disorders, and provide possibilities for incorporating imagery-based techniques in treatment interventions.
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Rask CU, Gehrt TB, Rimvall MK, Frostholm L. Health Anxiety. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Health anxiety, characterized by excessive concern about one’s health, is a serious and costly public health problem. The disorder might become chronic if left untreated. Unfortunately many patients do not receive timely or proper treatment due to sparse treatment resources. Also, existing treatment programs, though effective for many, do not work for all. This paper discusses the conceptualization of health anxiety and future directions based on novel research findings. These include: (i) the content and characteristics of autobiographical memories and episodic future thoughts in severe health anxiety, (ii) related concepts such as cyberchondria with excessive Internet browsing on health issues and health anxiety by proxy, where parents display and might confer health anxiety towards their children, (iii) an epidemiological perspective on the association between health anxiety and subclinical psychotic experiences in preadolescence. Exploring these new dimensions could have important implications for the further development of preventive strategies and effective treatment.
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Affiliation(s)
- Charlotte U. Rask
- Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tine B. Gehrt
- Center on Autobiographical Memory Research, Aarhus University, Aarhus, Denmark
| | - Martin K. Rimvall
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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A review on mental imagery in fear conditioning research 100 years since the ‘Little Albert’ study. Behav Res Ther 2020; 126:103556. [DOI: 10.1016/j.brat.2020.103556] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
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Antognelli SL, Sharrock MJ, Newby JM. A randomised controlled trial of computerised interpretation bias modification for health anxiety. J Behav Ther Exp Psychiatry 2020; 66:101518. [PMID: 31610436 DOI: 10.1016/j.jbtep.2019.101518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/24/2019] [Accepted: 09/29/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Health anxiety is characterised by a tendency to interpret benign bodily sensations as a sign of serious illness. This study aimed to examine whether computerised cognitive bias modification (CBM-I) training to facilitate benign interpretations of bodily symptoms could reduce these negative interpretations of bodily symptoms, health anxiety and comorbid symptoms. METHODS Participants (N = 89) with clinical levels of health anxiety (Short Health Anxiety Inventory [SHAI] scores ≥20) were randomised to receive two internet-delivered 30-min sessions of either CBM-I interpretation training (Intervention) or control CBM-I training over 1-week. Participants were assessed at pre-treatment, post-treatment and 2-weeks follow-up on self-reported health anxiety, cognitions and attributions of bodily symptoms, and comorbid symptoms (e.g., depression). RESULTS Results showed significantly reduced catastrophic attributions, health anxiety and related symptoms at post-treatment in both groups, which were maintained at 2-week follow-up. Although there were no significant group differences at post-treatment or follow-up, we found small non-significant effect sizes in favour of the CBM-I Intervention group on health anxiety and cognitions (Cohen's d's between-group effect sizes of 0.28 at post-treatment and d = 0.35 at follow-up on the 18-item Short Health Anxiety Inventory). LIMITATIONS The study was conducted online, limiting control over the setting in which participants completed training. Additionally, training was not tailored to the specific symptoms or diseases that participants feared. CONCLUSIONS This study is the first to evaluate the effect of internet-delivered CBM-I training targeting benign interpretations of bodily symptoms on health anxiety. Further research is needed before this intervention is disseminated.
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Imagery rescripting of early memories in health anxiety disorder: A feasibility and non-randomized pilot study. J Behav Ther Exp Psychiatry 2019; 65:101491. [PMID: 31176067 DOI: 10.1016/j.jbtep.2019.101491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 05/22/2019] [Accepted: 05/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Health anxiety is a common problem and is associated with frequent primary care visits, increased health care costs, and poor prognosis and low recovery rates. Previous research shows that imagery rescripting (IR) is a promising treatment technique for various disorders. To date, IR has not been examined as a viable treatment for health anxiety. The purpose of the present feasibility and pilot study was to test one session of IR of early anxiety-laden health-related memories in a small sample of patients suffering from HA. METHODS A within-groups design was used with a sample of 18 patients suffering from HA, who first underwent a control condition (reading about CBT), and then one week later a session of IR. After another week, the effects were measured on self-reported health anxiety and early anxiety provoking health-related mental images (memories). RESULTS After the IR intervention, significant reductions of health anxiety and health worry, as well as image and memory distress, vividness and frequency were observed. LIMITATIONS Among the most important limitations are the absence of an active control group, the small size of the sample, the absence of a longer follow-up, and the use of only self-report measures. CONCLUSIONS The results suggest that IR is a feasible technique in the treatment of health anxiety, and that more controlled research along these lines may be worthwhile.
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Leonidou C, Pollatos O, Panayiotou G. Emotional responses to illness imagery in young adults: Effects of attention to somatic sensations and levels of illness anxiety. Biol Psychol 2019; 149:107812. [PMID: 31722237 DOI: 10.1016/j.biopsycho.2019.107812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 01/06/2023]
Abstract
This study investigated the effect of interoceptive attention on emotional responses during illness imagery, and the moderating role of illness anxiety. 101 students (81 female; 18-35 years old) with low, moderate and high levels of illness anxiety had to imagine personally relevant illness scenarios and standardized fearful, joyful and neutral scenarios, after undergoing an attention manipulation to direct their attention towards interoceptive or exteroceptive stimuli. Emotional responses assessed included self-reports of arousal, valence and somatic sensations, and psychophysiological measures of heart rate reactivity and variability, skin conductance level, and facial electromyography. Findings showed increased reports of emotional arousal, negative affect and somatic symptoms, accompanied by negative emotion expressions, but a hypo-arousal physiological response pattern (i.e. low heart rate reactivity) during illness imagery after interoceptive attention, irrespective of illness anxiety levels. Under directed attention, the observed emotional response to illness imagery may increase the risk for developing and perpetuating illness anxiety.
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Affiliation(s)
| | - Olga Pollatos
- Institute of Psychology and Education, Ulm University, Germany
| | - Georgia Panayiotou
- Department of Psychology, University of Cyprus, Cyprus; Center of Applied Neuroscience, University of Cyprus, Cyprus
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Gehrt TB, Frostholm L, Obermann ML, Berntsen D. Autobiographical Memory and Episodic Future Thinking in Severe Health Anxiety: A Comparison with Obsessive–Compulsive Disorder. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10058-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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25
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Dysfunctional beliefs as mediators between illness-related intrusive thoughts and health anxiety symptoms. Behav Cogn Psychother 2019; 48:315-326. [PMID: 31597585 DOI: 10.1017/s1352465819000535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cognitive behavioural models of hypochondriasis assume that dysfunctional illness-related beliefs are involved in the genesis and maintenance of the disorder. The role that other more general dysfunctional beliefs about thoughts play in this disorder has also been highlighted. Internal triggers such as illness-related intrusive thoughts could activate these beliefs. AIM The present paper examines whether general dysfunctional beliefs about distressing thoughts, such as intolerance of uncertainty, over-estimation of threat, and thought-action fusion-likelihood, mediate between illness-related intrusive thoughts and health anxiety symptoms. METHOD A group of participants composed of individuals with hypochondriasis (n = 31; 51.5% women; mean age = 32.74 years, SD = 9.96) and community individuals (n = 219; 54.3% women; mean age = 39.56 years, SD = 15.20) completed a series of questionnaires to assess illness-related intrusive thoughts (INPIE), dysfunctional beliefs about thoughts (OBSI-R), and health anxiety symptoms (SHAI). RESULTS Results from a multiple parallel mediation analysis indicate that over-estimation of threat partially mediated the relationship between illness-related intrusive thoughts and health anxiety symptoms. CONCLUSIONS The results support the importance of the tendency to over-estimate the threat in the relationship between intrusive thoughts related to illness contents and health anxiety. Conceptual and clinical implications of these results are discussed.
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Gehrt TB, Niziurski JA, Frostholm L, Berntsen D. Encoding and retrieval biases for health-related scenes in patients with severe health anxiety .. Memory 2019; 27:1110-1121. [PMID: 31159637 DOI: 10.1080/09658211.2019.1626437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Severe health anxiety is a disorder characterised by excessive worries about harbouring or having a serious illness. The present study examines cognitive biases in evaluation and memory for health-related scenes in severe health anxiety in order to provide insights into the effect of these biases and the formation of illness intrusions in severe health anxiety. Twenty patients with severe health anxiety and 20 healthy participants completed a computerised task consisting of encoding, involuntary retrieval, voluntary retrieval and recognition of health-related, negative and neutral scenes. The results demonstrated that patients with severe health anxiety reported more negative emotional valence and greater physiological arousal to health-related scenes, both during encoding (ps < .031, ηp2 > .09) and retrieval (ps < .044, ds > 0.18). Furthermore, in contrast to the comparison group, patients with severe health anxiety did not show shorter retrieval time for health-related scenes during involuntary compared with voluntary retrieval (p = .789, d = 0.08), possibly due to greater demands on emotion regulation during involuntary retrieval. The results suggest an important role for negative emotional valence and physiological arousal to health-related stimuli in severe health anxiety, and highlight how cognitive biases in evaluation and memory might be at play in this disorder.
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Affiliation(s)
- Tine B Gehrt
- a Center on Autobiographical Memory Research , Aarhus University , Aarhus C , Denmark
| | - Julie A Niziurski
- a Center on Autobiographical Memory Research , Aarhus University , Aarhus C , Denmark.,b Department of Mathematics and Cognitive Psychology , Heinrich Heine Universität , Düsseldorf , Germany
| | - Lisbeth Frostholm
- c The Research Clinic for Functional Disorders , Aarhus University Hospital , Aarhus C , Denmark
| | - Dorthe Berntsen
- a Center on Autobiographical Memory Research , Aarhus University , Aarhus C , Denmark
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Kadriu F, Claes L, Witteman C, Norré J, Vrieze E, Krans J. Characteristics and content of intrusive images in patients with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2019; 27:495-506. [PMID: 30884049 PMCID: PMC6766953 DOI: 10.1002/erv.2671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 11/08/2022]
Abstract
The aim of this study was to examine the characteristics and content of intrusive images in patients with different subtypes of eating disorders (EDs). Data were collected from 74 ED patients, 22 dieting, and 29 nondieting controls. Participants completed a set of self-report questionnaires. Intrusive images of ED patients were significantly more repetitive, detailed, vivid, and distressing than intrusive images of dieting and/or nondieting controls. Most of the intrusive images were the same for the ED subtypes; however, patients with anorexia nervosa were more likely to report an observer vantage perspective than patients with bulimia nervosa, who were more likely to report a field vantage perspective. As expected, intrusive images' content was related to body checking (weight and shape) or negative self (evaluated by themselves or others). Finally, there were significant associations between intrusive images' vividness and weight and shape concerns. These findings indicate that intrusive images may be a core element of EDs and targeting intrusive images in therapy may be helpful.
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Affiliation(s)
- Fortesa Kadriu
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, 300 Leuven, Belgium.,Behavioural Science Institute, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, 300 Leuven, Belgium
| | - Cilia Witteman
- Behavioural Science Institute, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands
| | - Jan Norré
- People Development, Tiensevest 146, 3000 Leuven, Belgium and/or Free University of Brussels, Brussels, Belgium
| | - Elske Vrieze
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
| | - Julie Krans
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, 300 Leuven, Belgium.,Behavioural Science Institute, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands
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Pascual-Vera B, Akin B, Belloch A, Bottesi G, Clark DA, Doron G, Fernández-Alvarez H, Ghisi M, Gómez B, Inozu M, Jiménez-Ros A, Moulding R, Ruiz MA, Shams G, Sica C. The cross-cultural and transdiagnostic nature of unwanted mental intrusions. Int J Clin Health Psychol 2019; 19:85-96. [PMID: 31193125 PMCID: PMC6517647 DOI: 10.1016/j.ijchp.2019.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/11/2019] [Indexed: 12/26/2022] Open
Abstract
Background/Objective Unwanted mental intrusions (UMIs), typically discussed in relation to Obsessive-Compulsive Disorder (OCD), are highly prevalent, regardless of the specific nationality, religion, and/or cultural context. Studies have also shown that UMIs related to Body Dysmorphic Disorder (BDD), Illness anxiety/Hypochondriasis (IA-H), and Eating Disorders (EDs) are commonly experienced. However, the influence of culture on these UMIs and their transdiagnostic nature has not been investigated. Method Participants were 1,473 non-clinical individuals from seven countries in Europe, the Middle-East, and South America. All the subjects completed the Questionnaire of Unpleasant Intrusive Thoughts, which assesses the occurrence and discomfort of four UMI contents related to OCD, BDD, IA-H, and EDs, and symptom questionnaires on the four disorders. Results Overall, 64% of the total sample reported having experienced the four UMIs. The EDs intrusions were the most frequently experienced, whereas hypochondriacal intrusions were the least frequent but the most disturbing. All the UMIs were significantly related to each other in frequency and disturbance, and all of them were associated with clinical measures of OCD, BDD, IA-H, and EDs. Conclusions UMIs are a common phenomenon across different cultural contexts and operate transdiagnostically across clinically different disorders.
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Affiliation(s)
| | - Burcin Akin
- Department of Psychology, Hacettepe University, Turkey
| | - Amparo Belloch
- Department of Personality Psychology, Universidad de Valencia, Spain
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Italy
| | - David A Clark
- Department of Psychology, University of New Brunswick, Canada
| | - Guy Doron
- Department of Psychology, Interdisciplinary Center Herzliya, Israel
| | | | - Marta Ghisi
- Department of General Psychology, University of Padova, Italy
| | | | - Mujgan Inozu
- Department of Psychology, Hacettepe University, Turkey
| | | | | | - M Angeles Ruiz
- Universidad Nacional de Educación a Distancia UNED, Spain
| | - Giti Shams
- Department of Psychiatry, Tehran University of Medical Science, Roozbeh Hospital, Iran
| | - Claudio Sica
- Department of Human Health Science, University of Firenze, Italy
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Spontaneous future cognitions: an integrative review. PSYCHOLOGICAL RESEARCH 2018; 83:651-665. [PMID: 30535833 DOI: 10.1007/s00426-018-1127-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/04/2018] [Indexed: 12/16/2022]
Abstract
Spontaneous future cognitions refer to mental representations about the future that enter consciousness with no immediately preceding attempt of bringing them to mind. They are studied under different terms in several areas of psychology, but with little interdisciplinary exchange of findings and theoretical developments. Different conceptions of spontaneous future cognition derive from separate literatures and are rarely considered together, leaving their potential conceptual overlaps as well as their unique features unclarified. In this article, I review research on spontaneous future cognitions in relation to mind wandering, involuntary episodic future thoughts, and intrusive future imagery in cravings and clinical disorders. I conclude that more research is needed to clarify the potential functions served by spontaneous future cognitions in everyday life, under which conditions they may become dysfunctional, how they are triggered by situational cues, and how their content may be constrained by motivational factors and beliefs. The burgeoning field of spontaneous future cognitions forms a promising novel approach to the cognitive and motivational regulation of behavior in everyday life.
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Schneider A, Andrade J, Tanja-Dijkstra K, Moles DR. Mental imagery in dentistry: Phenomenology and role in dental anxiety. J Anxiety Disord 2018; 58:33-41. [PMID: 30025254 DOI: 10.1016/j.janxdis.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/16/2018] [Accepted: 06/22/2018] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Annegret Schneider
- Department of Clinical, Educational and Health Psychology, University College London, United Kingdom.
| | - Jackie Andrade
- School of Psychology, Cognition Institute, University of Plymouth, United Kingdom
| | - Karin Tanja-Dijkstra
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU Amsterdam, The Netherlands
| | - David R Moles
- Peninsula Schools of Medicine and Dentistry, University of Plymouth, United Kingdom
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Visser RM, Lau-Zhu A, Henson RN, Holmes EA. Multiple memory systems, multiple time points: how science can inform treatment to control the expression of unwanted emotional memories. Philos Trans R Soc Lond B Biol Sci 2018; 373:20170209. [PMID: 29352036 PMCID: PMC5790835 DOI: 10.1098/rstb.2017.0209] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2017] [Indexed: 01/04/2023] Open
Abstract
Memories that have strong emotions associated with them are particularly resilient to forgetting. This is not necessarily problematic, however some aspects of memory can be. In particular, the involuntary expression of those memories, e.g. intrusive memories after trauma, are core to certain psychological disorders. Since the beginning of this century, research using animal models shows that it is possible to change the underlying memory, for example by interfering with its consolidation or reconsolidation. While the idea of targeting maladaptive memories is promising for the treatment of stress and anxiety disorders, a direct application of the procedures used in non-human animals to humans in clinical settings is not straightforward. In translational research, more attention needs to be paid to specifying what aspect of memory (i) can be modified and (ii) should be modified. This requires a clear conceptualization of what aspect of memory is being targeted, and how different memory expressions may map onto clinical symptoms. Furthermore, memory processes are dynamic, so procedural details concerning timing are crucial when implementing a treatment and when assessing its effectiveness. To target emotional memory in its full complexity, including its malleability, science cannot rely on a single method, species or paradigm. Rather, a constructive dialogue is needed between multiple levels of research, all the way 'from mice to mental health'.This article is part of a discussion meeting issue 'Of mice and mental health: facilitating dialogue between basic and clinical neuroscientists'.
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Affiliation(s)
- Renée M Visser
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
| | - Alex Lau-Zhu
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Richard N Henson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
| | - Emily A Holmes
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
- Karolinska Institutet, Division of Psychology, Department of Clinical Neuroscience, Stockholm, Sweden
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Battaglini E, Liddell BJ, Das P, Malhi GS, Felmingham K, Bryant RA. An investigation of potential neural correlates of intrusive retrieval of distressing memories. J Behav Ther Exp Psychiatry 2018; 58:60-67. [PMID: 28886406 DOI: 10.1016/j.jbtep.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/03/2017] [Accepted: 08/12/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite the prevalence of intrusive memories across psychological disorders, little is known about the neural networks that underpin this form of memory. This study used functional magnetic resonance imaging (fMRI) to identify neural circuits associated with the retrieval of intrusive memories. METHODS Participants with moderate levels of anxiety (N = 30) underwent a cold pressor task to induce a physiological stress response, after which they viewed 10 neutral and 10 negative film clips. In a method designed to induce intrusive memories, participants then completed an fMRI scan in which they viewed short (2 s) depictions of neutral components from the original film clips. RESULTS There were no significant differences in activations during intrusion and non-intrusion responses. Exploratory analyses comparing intrusive responses to neutral stimuli found the insula, inferior frontal gyrus, precuneus, right cerebellum and bilateral supplementary motor area were uniquely activated during experience of intrusions (compared to the neutral cue baseline), whereas no significant activations were in response to negative scenes that did not trigger intrusions. LIMITATIONS This study did not compare the different neural processes implicated in intrusive and intentional emotional memories. The limited intrusions that could be elicited in the scanning environment restricted the number of trials that could be employed. CONCLUSIONS Although no differences in neural activations were observed between intrusive and non-intrusive responses, the observation of precuneus involvement is consistent with models that propose that intrusive memories are impacted by the extent to which there is contextual integration of the relevant memories.
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Pascual-Vera B, Belloch A. Functional links of obsessive, dysmorphic, hypochondriac, and eating-disorders related mental intrusions. Int J Clin Health Psychol 2017; 18:43-51. [PMID: 30487909 PMCID: PMC6220904 DOI: 10.1016/j.ijchp.2017.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/11/2017] [Indexed: 11/17/2022] Open
Abstract
Unwanted mental intrusions (UMIs) are the normal variants of obsessions in Obsessive-Compulsive Disorder (OCD), preoccupations about defects in Body Dysmorphic Disorder (BDD), images about illness in Hypochondriasis (HYP), and thoughts about eating in Eating Disorders (EDs). The aim was to examine the similarities and differences in the functional links of four UMI contents, adopting a within-subject perspective. Method: 438 university students and community participants (M age = 29.84, SD = 11.41; 70.54% women) completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT) to assess the functional links (emotions, appraisals, and neutralizing/control strategies) of the most upsetting UMIs with OCD, BDD, HYP and EDs-contents. Results: HYP-related intrusions caused the highest emotional impact, OCD-related intrusions were the most interfering, and EDs-related intrusions interfered the least. The four UMI were equally ego-dystonic. Women appraised OCD-related intrusions more dysfunctionally, but men appraised the four intrusive contents similarly. All UMI instigated the urge to "do something", to keep them under control and/or neutralizing them. Conclusions: Similarities among the functional links of intrusions related to OCD, BDD, HYP and EDs contents support their transdiagnostic nature and they might contribute to understanding common factors in these disorders.
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Affiliation(s)
- Belén Pascual-Vera
- Research and Treatment Unit for Obsessions and Compulsions (I'TOC), Universidad de Valencia, Spain
| | - Amparo Belloch
- Research and Treatment Unit for Obsessions and Compulsions (I'TOC), Universidad de Valencia, Spain
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Tolgou T, Rohrmann S, Stockhausen C, Krampen D, Warnecke I, Reiss N. Physiological and psychological effects of imagery techniques on health anxiety. Psychophysiology 2017; 55. [PMID: 28833227 DOI: 10.1111/psyp.12984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 07/19/2017] [Accepted: 07/28/2017] [Indexed: 12/24/2022]
Abstract
Previous research has shown that intrusions are part of the psychopathology of mental disorders. Imagery techniques seem to be an effective treatment of negative intrusions. Since negative mental imagery is part of health anxiety, the present study investigated the impact of imagery techniques on health anxiety. A total of 159 students with elevated scores in a health anxiety questionnaire watched an aversive film concerning a cancer patient and were randomly allocated to one of three interventions (positive imagery, imagery reexperiencing, imagery rescripting) or the control group. The intervention lasted 9 min. Physiological data (heart rate and cortisol) as well as psychological measures, such as mood ratings, health anxiety scores, and intrusions, were assessed during the appointment, while psychological measures were assessed over a period of 1 week after the intervention. Cortisol levels changed over time depending on the intervention. Heart rate changed during the 9-min interventions as well, with the fastest decrease during imagery rescripting. Moreover, negative mood and distress decreased after the intervention, while intrusions were reduced 1 week after the intervention in all groups equally. The results suggest that imagery rescripting is a promising technique that seems to activate a process of deep elaboration. Therefore, it might be an adequate way to target health anxiety symptoms such as anxiety, intrusions, and avoidance or safety-seeking behavior. Further studies should focus on imagery rescripting in clinical samples with health anxiety and target individual intrusive images to increase effectiveness. Nevertheless, the development of a long-term explanatory model of rescripting is needed.
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Affiliation(s)
- T Tolgou
- Department of Differential Psychology and Psychological Assessment, Goethe University, Frankfurt, Germany
| | - S Rohrmann
- Department of Differential Psychology and Psychological Assessment, Goethe University, Frankfurt, Germany
| | - C Stockhausen
- Institute of Computer Science, Goethe University, Frankfurt, Germany
| | - D Krampen
- Department of Educational Psychology, Goethe University, Frankfurt, Germany
| | | | - N Reiss
- Department of Differential Psychology and Psychological Assessment, Goethe University, Frankfurt, Germany
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Hedman E, Hesser H, Andersson E, Axelsson E, Ljótsson B. The mediating effect of mindful non-reactivity in exposure-based cognitive behavior therapy for severe health anxiety. J Anxiety Disord 2017; 50:15-22. [PMID: 28528015 DOI: 10.1016/j.janxdis.2017.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/20/2017] [Accepted: 04/26/2017] [Indexed: 01/26/2023]
Abstract
Exposure-based cognitive behavior therapy (CBT) has been shown to be effective in the treatment of severe health anxiety, but little is known about mediators of treatment effect. The aim of the present study was to investigate mindful non-reactivity as a putative mediator of health anxiety outcome using data from a large scale randomized controlled trial. We assessed mindful non-reactivity using the Five Facets Mindfulness Questionnaire-Non-Reactivity scale (FFMQ-NR) and health anxiety with the Short Health Anxiety Inventory (SHAI). Participants with severe health anxiety (N=158) were randomized to internet-delivered exposure-based CBT or behavioral stress management (BSM) and throughout the treatment, both the mediator and outcome were measured weekly. As previously reported, exposure-based CBT was more effective than BSM in reducing health anxiety. In the present study, latent process growth modeling showed that treatment condition had a significant effect on the FFMQ-NR growth trajectory (α-path), estimate=0.18, 95% CI [0.04, 0.32], p=.015, indicating a larger increase in mindful non-reactivity among participants receiving exposure-based CBT compared to the BSM group. The FFMQ-NR growth trajectory was significantly correlated with the SHAI trajectory (β-path estimate=-1.82, 95% CI [-2.15, -1.48], p<.001. Test of the indirect effect, i.e. the estimated mediation effect (αβ) revealed a significant cross product of -0.32, which was statistically significant different from zero based on the asymmetric confidence interval method, 95% CI [-0.59, -0.06]. We conclude that increasing mindful non-reactivity may be of importance for achieving successful treatment outcomes in exposure-based CBT for severe health anxiety.
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Affiliation(s)
- Erik Hedman
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
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Josefowitz N. Incorporating Imagery Into Thought Records: Increasing Engagement in Balanced Thoughts. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rachman S. Points of light. Behav Res Ther 2017; 88:2-6. [DOI: 10.1016/j.brat.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/05/2016] [Accepted: 08/11/2016] [Indexed: 11/30/2022]
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Reducing future fears by suppressing the brain mechanisms underlying episodic simulation. Proc Natl Acad Sci U S A 2016; 113:E8492-E8501. [PMID: 27965391 DOI: 10.1073/pnas.1606604114] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Imagining future events conveys adaptive benefits, yet recurrent simulations of feared situations may help to maintain anxiety. In two studies, we tested the hypothesis that people can attenuate future fears by suppressing anticipatory simulations of dreaded events. Participants repeatedly imagined upsetting episodes that they feared might happen to them and suppressed imaginings of other such events. Suppressing imagination engaged the right dorsolateral prefrontal cortex, which modulated activation in the hippocampus and in the ventromedial prefrontal cortex (vmPFC). Consistent with the role of the vmPFC in providing access to details that are typical for an event, stronger inhibition of this region was associated with greater forgetting of such details. Suppression further hindered participants' ability to later freely envision suppressed episodes. Critically, it also reduced feelings of apprehensiveness about the feared scenario, and individuals who were particularly successful at down-regulating fears were also less trait-anxious. Attenuating apprehensiveness by suppressing simulations of feared events may thus be an effective coping strategy, suggesting that a deficiency in this mechanism could contribute to the development of anxiety.
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Battaglini E, Liddell B, Das P, Malhi G, Felmingham K, Bryant RA. Intrusive Memories of Distressing Information: An fMRI Study. PLoS One 2016; 11:e0140871. [PMID: 27685784 PMCID: PMC5042442 DOI: 10.1371/journal.pone.0140871] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/01/2015] [Indexed: 11/18/2022] Open
Abstract
Although intrusive memories are characteristic of many psychological disorders, the neurobiological underpinning of these involuntary recollections are largely unknown. In this study we used functional magentic resonance imaging (fMRI) to identify the neural networks associated with encoding of negative stimuli that are subsequently experienced as intrusive memories. Healthy partipants (N = 42) viewed negative and neutral images during a visual/verbal processing task in an fMRI context. Two days later they were assessed on the Impact of Event Scale for occurrence of intrusive memories of the encoded images. A sub-group of participants who reported significant intrusions (n = 13) demonstrated stronger activation in the amygdala, bilateral ACC and parahippocampal gyrus during verbal encoding relative to a group who reported no intrusions (n = 13). Within-group analyses also revealed that the high intrusion group showed greater activity in the dorsomedial (dmPFC) and dorsolateral prefrontal cortex (dlPFC), inferior frontal gyrus and occipital regions during negative verbal processing compared to neutral verbal processing. These results do not accord with models of intrusions that emphasise visual processing of information at encoding but are consistent with models that highlight the role of inhibitory and suppression processes in the formation of subsequent intrusive memories.
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Affiliation(s)
| | | | | | - Gin Malhi
- University of Sydney, Sydney, Australia
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40
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When fear of cancer recurrence becomes a clinical issue: a qualitative analysis of features associated with clinical fear of cancer recurrence. Support Care Cancer 2016; 24:4207-18. [PMID: 27169700 DOI: 10.1007/s00520-016-3248-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Fear of cancer recurrence (FCR) is a common experience for cancer survivors. However, it remains unclear what characteristics differentiate non-clinical from clinical levels of FCR. The goal of this study was to investigate the potential hallmarks of clinical FCR. METHODS A convenience sample of 40 participants (n = 19 female) was drawn from another study (Lebel et al. in Qual Life Res 25:311-321. doi: 10.1007/s11136-015-1088-2 , 2016). The semi-structured interview for fear of cancer recurrence (Simard and Savard in J Cancer Surviv 9:481-491. doi: 10.1007/s11764-015-0424-4 , 2015) was used to identify participants with non-clinical and clinical FCR and qualitative analysis of these interviews was performed. RESULTS Individuals with clinical FCR reported the following features: death-related thoughts, feeling alone, belief that the cancer would return, experiencing intolerance of uncertainty, having cancer-related thoughts and imagery that were difficult to control, daily and recurrent, lasted 30 minutes or more, increased over time, caused distress and impacted their daily life. Triggers of FCR and coping strategies did not appear to be features of clinical FCR as they were reported by participants with a range of FCR scores. CONCLUSIONS While features of clinical FCR found in this analysis such as intrusive thoughts, distress and impact on functioning confirmed previous FCR research, other features spontaneously emerged from the interviews including "death-related thoughts," "feeling alone," and "belief that the cancer will return." The participants' descriptions of cancer-specific fear and worry suggest that FCR is a distinct phenomenon related to cancer survivorship, despite similarities with psychological disorders (e.g., Anxiety Disorders). Future research investigating the construct of FCR, and the distinguishing features of clinical FCR across a range of cancer types and gender is required.
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41
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Catastrophic Thinking: A Transdiagnostic Process Across Psychiatric Disorders. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9763-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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42
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Görgen SM, Hiller W, Witthöft M. Die Spontaneous Use of Imagery Scale (SUIS)–Entwicklung und teststatistische Prüfung einer deutschen Adaption. DIAGNOSTICA 2016. [DOI: 10.1026/0012-1924/a000135] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Mentale Vorstellungsbilder spielen bei zahlreichen kognitiven, motorischen und emotionalen Prozessen eine bedeutende Rolle. Die Spontaneous Use of Imagery Scale (SUIS; Kosslyn, Chabris, Shephard & Thompson, 1998 ) ist ein Selbstbeurteilungsinstrument zur Erfassung von interindividuellen Unterschieden hinsichtlich des alltäglichen Gebrauchs mentaler Vorstellungsbilder. In zwei Studien wurde eine deutsche Adaption der SUIS entwickelt und psychometrisch erprobt. Mittels konfirmatorischer Faktorenanalyse wurde in beiden Studien die Eindimensionalität der Skala nachgewiesen. Erste Validitätshinweise ergeben sich aus Beziehungen der SUIS zu Maßen von bildhaften (visuell-imaginativen) sowie verbal-gedanklichen kognitiven Stilen (Studie 1, N = 216). Mit der deutschen Version konnten auch positive Zusammenhänge mit Hypomanie repliziert werden. In der zweiten Studie (N = 447) konnte die interne Konsistenz der deutschen Version durch eine Erweiterung der Skala deutlich verbessert werden. Mit der erweiterten Version der SUIS liegt nun erstmalig für den deutschsprachigen Raum ein Instrument vor, das die Imaginationsneigung reliabel erfassen kann.
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Veale D, Page N, Woodward E, Salkovskis P. Imagery Rescripting for Obsessive Compulsive Disorder: A single case experimental design in 12 cases. J Behav Ther Exp Psychiatry 2015; 49:230-236. [PMID: 25805628 DOI: 10.1016/j.jbtep.2015.03.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/22/2015] [Accepted: 03/02/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Some individuals with Obsessive Compulsive Disorder (OCD) may experience recurrent intrusive distressing images, which may be emotionally linked to past aversive memories. Our aim was to investigate whether Imagery Rescripting was an effective intervention for such individuals with OCD. METHOD Twelve cases who experienced intrusive distressing images are presented in a A1BA2CA3 single case experimental design. After a baseline of symptom monitoring (A1), participants had a control intervention of talking about the memory related image (B), followed by symptom monitoring (A2), a single session of Imagery Rescripting (C) and further monitoring for up to 3 months (A3). RESULTS Minimal change was seen following the control intervention. However, at 3 months following ImRs, there was a drop in the Yale-Brown Obsessive Compulsive Scale, with a decrease from a mean of 24.1 to 10.7. Reliable improvement was achieved in 9 out of the 12 cases and clinically significant change in 7 out of 12 at 3-month follow up. The limitations are that all cases were selected on the basis that they had an aversive memory linked to their imagery. CONCLUSIONS Imagery Rescripting is a promising therapeutic technique for OCD as an adjunct to CBT where intrusive images are linked to aversive memories.
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Affiliation(s)
- David Veale
- The Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK; The South London and Maudsley NHS Foundation Trust, SE5 8AF, UK.
| | - Nicholas Page
- The Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK; The South London and Maudsley NHS Foundation Trust, SE5 8AF, UK
| | - Elizabeth Woodward
- The Institute of Psychiatry, Psychology and Neurosciences, King's College London, UK; The South London and Maudsley NHS Foundation Trust, SE5 8AF, UK
| | - Paul Salkovskis
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
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Thewes B, Lebel S, Seguin Leclair C, Butow P. A qualitative exploration of fear of cancer recurrence (FCR) amongst Australian and Canadian breast cancer survivors. Support Care Cancer 2015; 24:2269-2276. [PMID: 26581900 PMCID: PMC4805701 DOI: 10.1007/s00520-015-3025-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/08/2015] [Indexed: 11/25/2022]
Abstract
Purpose Few studies have explored coping strategies used by cancer survivors to deal with fear of cancer recurrence (FCR), and little research has been conducted on the specific content of recurrence fears. This study aims to qualitatively explore the strategies used by younger breast cancer survivors to cope with FCR and whether women with low, medium and high levels of FCR employ different coping strategies. An additional aim was to understand the specific content of worst recurrence fears. Method Twenty Australian and 10 Canadian women aged ≤45 years diagnosed with stages 0–II disease at least 1 year prior completed telephone interviews. The transcripts of audio-taped interviews were analysed using the qualitative methodology of transcendental realism. Results Women with higher FCR described using distraction and avoidance and fewer coping skills. The fear of death was a common worst fear at all levels of FCR. However, participants with higher FCR described more elaborate fears of death often involving themes of pain and suffering. Cross-cultural differences were not observed. Conclusions Women with higher FCR report using fewer and more avoidance-based coping techniques. Whilst many participants feared death, those with higher FCR reported more elaborate death fears. Women with high levels of FCR may benefit from learning a greater repertoire of coping skills. Understanding the specific content of FCR can help refine existing psychological treatment protocols for FCR. Implications for FCR treatment are discussed.
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Affiliation(s)
- B Thewes
- Department of Medical Psychology, Radboud University Medical Centre, Postbus 9101, 6500 HB, Nijmegen (840), The Netherlands. .,School of Psychology, The University of Sydney, Sydney, Australia.
| | - S Lebel
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Montfort Hospital Research Institute, Ottawa, ON, Canada
| | | | - P Butow
- School of Psychology, The University of Sydney, Sydney, Australia
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Sansom-Daly UM, Bryant RA, Cohn RJ, Wakefield CE. Rumination and self-defining memories in the context of health concerns. Memory 2015; 24:939-48. [PMID: 26273962 DOI: 10.1080/09658211.2015.1059860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Individuals with health anxiety report experiencing a strong sense of vulnerability to illness. Such beliefs may be driven by the biased recollection of past illness-related events. However, little research has explored the role of memory in health anxiety. In other disorders, rumination has also been identified as a process that leads individuals to recall memories dominated by the content of their concerns. This study examined the proposition that rumination might impact the content of "self-defining" autobiographical memories among 60 college students with varying health anxiety (35% with clinical-level health anxiety). Participants were randomised to experiential/ruminative self-focus conditions, and then they completed the Self-Defining Memory Task. Responses were coded for valence and illness-relatedness. Results indicated that rumination led participants to retrieve more illness-related self-defining memories, while higher health anxiety scores were associated with more negative, but not more illness-focused memories. Ruminative thinking appears to activate health concerns, and may play a role in maintaining ongoing health anxiety.
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Affiliation(s)
- Ursula M Sansom-Daly
- a School of Psychology , University of New South Wales (UNSW) , Kensington , Australia.,b Kids Cancer Centre , Sydney Children's Hospital , Randwick , Australia.,c School of Women's and Children's Health , University of New South Wales (UNSW) , Kensington , Australia
| | - Richard A Bryant
- a School of Psychology , University of New South Wales (UNSW) , Kensington , Australia
| | - Richard J Cohn
- b Kids Cancer Centre , Sydney Children's Hospital , Randwick , Australia.,c School of Women's and Children's Health , University of New South Wales (UNSW) , Kensington , Australia
| | - Claire E Wakefield
- b Kids Cancer Centre , Sydney Children's Hospital , Randwick , Australia.,c School of Women's and Children's Health , University of New South Wales (UNSW) , Kensington , Australia
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van Houtem CMHH, van Wijk AJ, de Jongh A. Presence, Content, and Characteristics of Memories of Individuals with Dental Phobia. APPLIED COGNITIVE PSYCHOLOGY 2015. [DOI: 10.1002/acp.3127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Caroline M. H. H. van Houtem
- Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University Amsterdam; Amsterdam The Netherlands
| | - Arjen J. van Wijk
- Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University Amsterdam; Amsterdam The Netherlands
| | - Ad de Jongh
- Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA); University of Amsterdam and VU University Amsterdam; Amsterdam The Netherlands
- School of Health Sciences; Salford University; Manchester UK
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Çili S, Stopa L. Intrusive Mental Imagery in Psychological Disorders: Is the Self the Key to Understanding Maintenance? Front Psychiatry 2015; 6:103. [PMID: 26236244 PMCID: PMC4505071 DOI: 10.3389/fpsyt.2015.00103] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 07/03/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Soljana Çili
- London College of Fashion, University of the Arts London , London , UK
| | - Lusia Stopa
- Psychology Academic Unit, University of Southampton , Southampton , UK
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Çili S, Stopa L. The retrieval of self-defining memories is associated with the activation of specific working selves. Memory 2014; 23:233-53. [DOI: 10.1080/09658211.2014.882955] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sansom-Daly UM, Bryant RA, Cohn RJ, Wakefield CE. Imagining the future in health anxiety: the impact of rumination on the specificity of illness-related memory and future thinking. ANXIETY STRESS AND COPING 2014; 27:587-600. [DOI: 10.1080/10615806.2014.880111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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