Changes in negative implicit evaluations in patients of hypochondriasis after treatment with cognitive therapy or exposure therapy

Effects on the Affect Misattribution Procedure are strongly moderated by influence awareness

The Affect Misattribution Procedure (AMP) is used in many areas of psychological science based on the assumption that it not only taps into attitudes and biases but does so without a person's awareness. Across eight preregistered studies (N = 1603) plus meta-analyses, we reexamined the 'implicitness' of AMP effects, and in particular, the idea that people are unaware of the prime's influence on their evaluations. Results indicated that AMP effects and their predictive validity are primarily moderated by a subset of influence-aware trials (within individuals), and high rates of influence awareness (between individuals). Interestingly, an individual's influence-awareness rate on one AMP predicted how they performed on an earlier AMP, even when the two assessed different attitude domains. Taken together, our results suggest that AMP effects are not implicit in the way that has been claimed, a finding that has implications for the procedure, past findings, and theory. All materials and data are available at osf.io/gv7cm.

Medically unexplained symptoms in children and adolescents: Illness-related self-concept and parental symptom evaluations

BACKGROUND AND OBJECTIVES

According to cognitive-behavioral models, illness-related symptom evaluations and self-concepts play a pivotal role in the development and maintenance of medically unexplained somatic symptoms (MUS). However, illness-related cognitions related to MUS have rarely been studied in children/adolescents and their parents.

METHODS

Seventy-eight children and adolescents (M = 14.2 years; 59% female) performed two versions of the Implicit Association Test (IAT) to measure the implicit illness-related and the implicit anxiety-related self-concept. Illness-related evaluations of unspecific symptoms were assessed via the Health Norms Sorting Task (HNST), and MUS as well as characteristics of somatic symptom disorder (SSD) via questionnaires.

RESULTS

MUS were significantly positively associated with the explicit (r = 0.30, p < .01) and implicit illness-related self-concept (r = 0.24, p = .04), but not with the anxiety-related self-concept (r = 0.15, p = .18). The implicit illness-related self-concept explained incremental variance in MUS (ΔR² = 0.05, p = .04) beyond the explicit illness-related self-concept. Regarding health anxiety, parental illness-related symptom evaluations moderated the relationship between child-reported severity of MUS and health anxiety (B = 0.12, p < .01).

LIMITATIONS

Some measures have been adapted for childhood and adolescence, but validations on larger samples are still pending.

CONCLUSIONS

A disorder-specific self-concept of being ill, as well as parental symptom evaluations, seem to play an essential role in MUS and health anxiety in childhood and adolescence. Due to the importance of the top-down processes found here, the findings are in line with current predictive coding models of somatic symptom perception.

Illness Anxiety Disorder: Psychopathology, Epidemiology, Clinical Characteristics, and Treatment

Illness anxiety disorder is a primary disorder of anxiety about having or developing a serious illness. The core feature is the cycle of worry and reassurance seeking regarding health, as opposed to a focus on relief of distress caused by somatic symptoms (as in Somatic Symptom Disorder). Clinically significant health anxiety is common, with estimates ranging up to 13% in the general adult population. There are evidence-based treatments, including psychopharmacology and cognitive behavioral therapy, that can significantly alleviate symptoms. An understanding of the core psychopathology and clinical features of illness anxiety disorder is essential to fostering a working alliance with patients with health anxiety, as is the maintenance of an empathic, curious, and nonjudgmental stance toward their anxiety. Collaboration between medical providers is essential to avoid the pitfalls of excess testing and medical treatment.