Effects of suppression and appraisals on thought frequency and distress

Cognitive theories of obsessions highlight appraisals of personal significance and thought suppression in the development and maintenance of intrusive thoughts. The current study examined the role of personal significance within the context of a thought suppression paradigm. The primary aim was to examine whether suppression would have differential effects for target thoughts appraised as personally meaningful versus relatively unimportant. A blasphemous thought served as the target thought, and highly religious and nonreligious participants were recruited. Participants completed a two-interval thought suppression task; during interval 1 they were randomly assigned to suppress or not suppress the target thought and during interval 2, all participants were given “do not suppress” instructions. Suppression resulted in sustained frequency of thoughts in contrast to the decline in thought frequency observed for non-suppression. Differential effects of suppression were found across the two groups. Moreover, suppression was associated with increased negative mood and anxiety. Results suggest that suppression of personally meaningful thoughts is a counterproductive strategy.     

Implicit and explicit appraisals of the importance of intrusive thoughts

To evaluate cognitive theories of obsessions, the current study experimentally manipulated appraisals of the importance of intrusive thoughts. Undergraduate students (N = 156) completed measures of obsessive-compulsive disorder (OCD) symptoms and beliefs and were primed with a list of commonly reported unwanted thoughts. Participants were then informed that unwanted thoughts are either (1) significant and indicative of their personal values, or (2) meaningless, or participants (3) received no instructions about unwanted thoughts. Participants then completed implicit and explicit measures of self-evaluation and interpretations of their unwanted thoughts. Results indicated that the manipulation shifted implicit appraisals of unwanted thoughts in the expected direction, but not self-evaluations of morality or dangerousness. Interestingly, explicit self-esteem and beliefs about the significance of unwanted thoughts were associated with measures of OCD beliefs, whereas implicit self-evaluations of dangerousness were better predicted by the interaction of pre-existing OCD beliefs with the manipulation. Results are discussed in terms of divergent predictors of implicit and explicit responses to unwanted thoughts.     

Role of thought-related beliefs and coping strategies in the escalation of intrusive thoughts: an analog to obsessive-compulsive disorder

Cognitive-behavioral models of obsessive-compulsive disorder (OCD) assume that obsessions have their origin in normal intrusive thoughts. These models propose that certain beliefs, such as thought-action fusion (TAF) beliefs, combined with the use of ineffective coping strategies, such as thought suppression, lead to the development of OCD. The purpose of the current study was to examine the relationship between these variables in a non-clinical sample in addition to exploring the effects of an alternative, acceptance-based coping strategy. This study explored the relationship between TAF beliefs, thought suppression, and OC-consistent symptoms via mediational analyses. Results showed that thought suppression mediated the relationship between TAF beliefs and OC-consistent symptoms. This study also experimentally examined the effects of various coping strategies (suppression, acceptance, or monitor-only) on the frequency of a distressing intrusion and appraisal ratings (e.g., anxiety, guilt, responsibility) after a TAF induction. Spontaneous suppression in the monitor-only group made comparisons of the experimental data difficult. However, analyses provided preliminary evidence suggesting that thought suppression is related to more intrusions, higher levels of anxiety, and negative appraisals, whereas an acceptance-based approach may be a useful alternative. Additional findings, limitations of the current study, and directions for future research are discussed.     

Role of prior negative cognitions on the development of intrusive thoughts

This analogue study examined how individuals' prior negative cognitions influenced intrusion frequency, intrusion‐related distress and thought suppression. Participants at high (HR) and low risk (LR) for interpreting their intrusive thoughts in a negative manner viewed a graphic trauma film and their subsequent intrusion development was assessed. HR participants experienced a greater frequency of intrusions and intrusion‐related distress compared to LR participants. Trait thought suppression moderated the relationship between risk for the negative interpretation of intrusions and intrusion frequency. The findings suggest that pre‐existing negative cognitions are influential in the development of intrusions following exposure to an analogue trauma.     

Ageing and thought suppression performance: Its relationship with working memory capacity,habitual thought suppression and mindfulness

A study investigated how the ability to suppress thoughts in the laboratory was affected by type of thought suppressed (positive, negative, neutral), participants’ age and working memory capacity (WMC). Linked variables (Use of thought suppression, social desirability, and mindfulness) were measured to assess whether they modified susceptibility to thought intrusion.Younger, middle aged and older adults suppressed three different valenced thoughts in a counterbalanced order for 5-min per thought. Participants then completed a WMC task and questionnaire measures of the linked variables.Valence had no effect on intrusions. WMC was positively related to intrusions; higher WMC corresponded to greater intrusions. Age was negatively related to intrusions; with increasing age intrusions decreased. Hierarchical regression showed only age and backward digit span (WMC) significantly predicted intrusions. The relationship between WMC and intrusions was not moderated by age. WMC and age both independently predict level of intrusion, and no synergistic effect was found.     

Suppressing and focusing on a negative memory in social anxiety: effects on unwanted thoughts and mood

Researchers have hypothesized that thought suppression contributes to the large volume of unwanted thoughts in anxiety disorders. However, comparisons to both non-suppression and non-anxious groups are necessary for studies on thought suppression in high anxiety. Participants completed a series of thought verbalization periods and a social interaction. During one period, participants were randomly assigned to focus upon a negative social memory, suppress it, or think freely while monitoring the memory. Results indicated that thought suppression and focusing caused a greater rise and subsequent decline in unwanted thoughts than monitoring instructions for both high and low social anxiety groups. Importantly, highly socially anxious participants had more unwanted thoughts overall, but did not respond significantly differently to thinking instructions when compared to the less anxious group. Interestingly, highly socially anxious participants did report more thought suppression attempts in their everyday life. They also appeared to benefit by experiencing less shyness after suppression when compared to focusing, a pattern not evident for the low social anxiety group.     

Appraisals of obsessional thoughts in normal samples

Cognitive theories of obsessive-compulsive disorder (OCD) posit that appraisals about the significance of thoughts are critical in the development and persistence of obsessions. Rachman [(1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793-802.] proposes that appraisals of unwanted thoughts distinguish clinical obsessions from normal intrusive thoughts; thoughts appraised as important and personally significant are expected to be upsetting and recur. Appraisals are also expected to be related to symptoms of OCD. To explore the features of normal appraisals of obsession-like thoughts, nonclinical participants in two studies rated the personal significance of intrusive thoughts portrayed in vignettes containing prototypical themes associated with primary obsessions: aggressive, sexual, and blasphemous thoughts. Unwanted intrusive thoughts that were described as occurring more frequently were appraised as more personally significant, but participants appraised these socially unacceptable thoughts similarly whether they imagined having personally experienced them or a friend confiding about having experienced them. Appraisals in both studies were related to subclinical OC symptoms and OC beliefs.     

Thought suppression failures in combat PTSD: A cognitive load hypothesis

The present study investigated the relation between thought suppression of emotionally neutral content [i.e., Wegner's (1994) “white bear”], incidental traumatic thought intrusion, and skin conductance responses in combat-related Posttraumatic Stress Disorder (PTSD). Participants included service members who either: a) had PTSD following an Operation Iraqi Freedom deployment; b) were free of psychiatric diagnosis following deployment (Combat Equivalent), or c) were pre-deployed and without psychiatric diagnosis (Pre-Deployed). PTSD Service Members reported the greatest intrusion of combat thoughts during the suppression task and demonstrated a post-suppression rebound effect with a neutral thought. Non-specific skin conductance responses indicated that the suppression task was related to similar levels of increased sympathetic activity for both the PTSD and Pre-Deployed groups, whereas the Combat Equivalent group showed no increased activation during thought suppression. Intrusive traumatic thoughts combined with failures in neutral thought suppression may be a consequence of increased cognitive load in PTSD.     

On becoming neutral: effects of experimental neutralizing reconsidered

Behaviour Research and Therapy 34 (1996) 889–898 found that writing out a negative thought produced anxiety and an urge to neutralize the thought, that instructing participants to neutralize the thought reduced anxiety/neutralization urge in the short run (i.e. within 2 min), but that in the control group 20 min without instruction was attended by the same reduction in anxiety/urge to neutralize (“natural decay”). The observations were made with pariticipants who scored high on “thought action fusion” and the experiment was set up as exerimental model of obsessions. We repeated the study with participants that were not selected on thought action fusion. All the findings reported by Behaviour Research and Therapy 34 (1996) 889–898 were replicated. Correlational analysis indicated that the strength of the effect was not related to scores on scales measuring “thought action fusion”. Behaviour Research and Therapy 34 (1996) 889–898 did not assess whether non-neutralizing was followed by immediate reductions in distress. We did assess this and found that the larger part of the immediate reduction of distress after neutralization also occurs when no neutralization instruction is given. The effects of neutralization instructions in the present type of experiment are considerably less powerful than suggested earlier.     

Suppression-induced hyperaccessibility of thoughts in abstinent alcoholics: a preliminary investigation

Abstinent alcoholics were compared to a non-alcoholic control group on a modified Stroop color-naming task. Alcoholics took significantly longer to name the color of the word "alcohol" than to name the color of non-alcohol words (i.e., they showed an interference effect) after they had first tried to suppress thoughts of alcohol. Alcoholics who had freely expressed thoughts about alcohol prior to the Stroop did not show such interference. Control participants who had suppressed thoughts of alcohol showed no interference effect. The results overall suggest that when alcoholics try to suppress thoughts of alcohol, these thoughts may become hyperaccessible immediately afterward.     

The paradoxical effects of suppressing anxious thoughts during imminent threat

In line with the ironic processing theory of Wegner (Psychol. Rev. 101 (1994) 34), it is often argued that the suppression of anxiety-related thoughts results in a paradoxical increase of anxiety and thought intrusions, both after and during the thought suppression. In a sample of undergraduate students (14 men, 18 women), we investigated the effects of suppressing anxious thoughts about an imminent painful electrocutaneous stimulus. During thought suppression, self-reported anxiety and frequency of anxious thoughts did not increase, and duration of anxious thoughts decreased. After thought suppression, participants experienced an increase in self-reported anxiety and the frequency of anxious thoughts. There was no effect upon thought duration. The results support the idea that suppression of anxiety-related thoughts may result in a paradoxical increase in anxiety, and may cause and/or maintain anxiety problems.     

The tendency to suppress, inhibiting thoughts, and dream rebound

Ironic control theory proposes that suppressing thoughts leads to increased occurrence of the suppressed thought because monitoring for the unwanted thought leads to intrusions. This study investigated the influence of suppressing unwanted thoughts on dream content. One hundred participants who had high or low levels of tendency to suppress unwanted thoughts nominated an intrusive thought, and half of the participants were instructed to suppress that thought for 5 min prior to sleeping. Participants completed a dream diary upon waking, which was subsequently rated by independent raters for dream content. In terms of the 79 participants who reported dreaming, more high suppressors who were instructed to suppress dreamt about the intrusive thought than high suppressors in the control condition. There was no difference between low suppressors in the suppression and control conditions. These results suggest that dream content can be influenced by attempted suppression prior to sleep, and this is particularly apparent in people with a tendency to suppress unwanted thoughts.     

The Meta-Cognitive Beliefs Questionnaire: development of a measure of obsessional beliefs

A 67 item self-report questionnaire called the Meta-Cognitive Beliefs Questionnaire (MCBQ) was developed to assess endorsement of beliefs about the importance of control and negative consequences associated with unwanted, ego-dystonic intrusive thoughts, images and impulses. The MCBQ and a battery of questionnaires that assessed symptoms and cognitions of worry, obsessive-compulsive disorder, anxiety, and depression were administered to large samples of undergraduate students. Beliefs about control of intrusive thoughts and perceived negative consequences due to uncontrolled mental intrusions had a unique significant relationship with obsessions, and to a lesser extent, worry. These findings are consistent with current cognitive behavioral theories that suggest an important role for meta-cognitive beliefs in the pathogenesis of obsessions.     

Investigation of the indulgence cycles hypothesis of suppression on experimentally induced visual intrusions in dysphoria

Within the thought control literature, Wegner [(1989). White bears and other unwanted thoughts: Suppression, obsession, and the psychology of mental control. New York, NY, USA: Penguin Press.] referred to the combined initial suppression and expression phases of thought control as an indulgence cycle which results in the rebound effect typically observed in suppression studies. According to Ironic Process Theory [Wegner, (1994). Ironic processes of mental control. Psychological Review, 101, 34-52.], this rebound leads to further attempts to suppress that are difficult due to the target thought's hyperaccessibility, resulting in a secondary rebound effect owing to a positive feedback system of indulgence cycles. The current study investigated (i) the effects of repeated suppression and opportunities for expression by using a method to index the frequency, duration, and associated levels of distress of an experimentally induced visual intrusion, and (ii) whether any observed effects were differentially linked to depressive symptomatology in an analogue sample of low and high dysphoric participants. Results supported a secondary rebound effect in those participants most successful at suppressing target intrusions. The findings offer an important extension to the emerging literature on the management of intrusive memories in depression.     

Managing unwanted intrusive thoughts in obsessive-compulsive disorder: Relative effectiveness of suppression, focused distraction, and acceptance

Suppression is one of various mental control techniques that people may use to manage unwanted thoughts. Evidence suggests that it is at best unsustainable and at worst counterproductive. This leads to the question: If suppression is a futile way to respond to unwanted, intrusive thoughts, what is a more effective alternative? In the current study, we evaluated the relative effectiveness of suppression and two alternative mental control techniques—focused distraction and acceptance—on the frequency of intrusions and distress associated with them. Results support the claim that suppression is a counterproductive technique for dealing with unwanted, intrusive thoughts in OCD. However, the harmfulness of suppression was reflected primarily in the magnitude of distress and not in intrusion frequency. Focused distraction and acceptance were the more effective techniques for managing clinically significant intrusive thoughts. We discuss implications for the cognitive treatment for OCD.     

Suppression of obsession-like thoughts in nonclinical individuals: impact on thought frequency, appraisal and mood state

Wegner's (1994, Psychological Review, 101, 34-52) research on the paradoxical effect of thought suppression has been incorporated into contemporary cognitive-behavioural models of obsessive-compulsive disorder. However, findings on the effects of thought suppression on thought frequency have been inconsistent and few studies have actually examined the suppression of thoughts that are obsessional in nature. In the present study 219 nonclinical participants were randomly assigned to suppress or not suppress a neutral, obsessional or positive thought during an initial monitoring interval. In a second thought monitoring interval, all participants received instructions not to suppress their target thought. No paradoxical effect of suppression on frequency was observed for any type of thought, although suppression of obsessional thoughts was associated with greater subsequent discomfort and a more negative mood state than suppression of positive or neutral target thoughts.     

Thought suppression and its effects on thought frequency, appraisal and mood state in individuals with obsessive-compulsive disorder

Leading models of obsessive-compulsive disorder (OCD) implicate thought suppression as a key factor in the escalation and persistence of the disorder. This experiment examined the effects of suppression on the frequency of obsessional thoughts in 50 individuals with a primary diagnosis of OCD, and also investigated the effects of participants' appraisals regarding their failures in thought control on distress about intrusive thoughts and on mood. Participants' most upsetting obsessional thought was primed and they then monitored its occurrence over two 4-min intervals. In the first interval, half of the participants were instructed to suppress their obsessional thought and half were instructed not to suppress any thoughts. In the second interval, all participants were given the 'Do Not Suppress' instructions. Participants rated their suppression effort and discomfort over thought occurrences after each interval and recorded their appraisals of thought recurrences during the first interval. Mood state was then reassessed. No ironic effect of suppression on frequency was noted. However, negative appraisals of thought recurrences were associated with more discomfort over thought occurrences and more negative mood at Time 2. These findings suggest that interpretations regarding failures in thought control may be of central importance in understanding obsessional problems.     

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

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

Dream rebound of suppressed emotional thoughts: the influence of cognitive load

Initial evidence suggests that suppressing a thought prior to sleep results in subsequent dreaming of that thought. The present research examined the influence of cognitive load on dreaming following suppression. In Experiment 1, 100 participants received either a suppression instruction or no instruction for an intrusive thought prior to sleep, and subsequently completed a dream diary. Participants instructed to suppress reported dreaming about the target thought more than controls; dream rebound was predicted by poorer performance on a working memory task. In Experiment 2, 126 participants received either a suppression instruction or no instruction for an intrusive thought prior to sleep, and half of participants also had cognitive load of learning a 9-digit number. Participants receiving the suppression instruction under cognitive load reported greater dream rebound than other participants. These findings indicate that thought suppression prior to sleep leads to dream rebound, and this effect is enhanced by cognitive load.     

Cognitive defusion and self-relevant negative thoughts: examining the impact of a ninety year old technique

Cognitive defusion techniques are designed to reduce the functions of thoughts by altering the context in which they occur, rather than the attempting to alter the form, frequency, or situational sensitivity of the thoughts themselves. Applied technologies designed to produce cognitive defusion seem to lead to reductions in the believability of negative thoughts, but defusion techniques are generally only parts of complex packages and the role of defusion techniques per se is note yet known. The present study examined the impact of a cognitive defusion technique first described by Titchener nearly 90 years ago: rapidly repeating a single word. In series of eight single-case alternating treatment designs, this defusion technique was compared to a distraction task, and to a thought control task on reductions in the discomfort and believability of self-relevant negative thoughts. The cognitive defusion technique reduced both discomfort and believability more so than the comparison approaches. Control studies showed that the effect was probably not due to demand characteristics.