Thought suppression: specificity in agoraphobia versus broad impairment in social phobia?

The paradoxical effects of intended thought suppression have been linked to psychological disorders, specifically anxiety disorders. So far, the evidence for thought suppression playing a major role in the disorder is mixed. One important issue is whether thought suppression is impaired only for thoughts related to the disorder, or if the ability for mental control is generally impaired in anxiety patients. This study compared groups of agoraphobics and social phobics with a healthy control group. All subjects were asked to suppress two topics related to the respective central fear of the two disorders and one nonspecific topic. We found a rather specific deficit in thought suppression for the agoraphobics; that is, when compared with the control group, we found the biggest differences for the agoraphobic fear. The social phobics seem to be characterized by a general impairment of mental control, affecting specific and nonspecific stimuli. In addition, among several psychopathological variables, social anxiety proved to be the strongest predictor for problems with thought suppression. Taken together, there are several indicators that generally impaired thought suppression may be an important feature of social phobia.     

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.     

事与愿违？思维抑制中的立即增强效应和延迟反弹效应

思维抑制作为一种重要的自我调节策略,对维护个体的心理健康具有重要意义。但在思维抑制的过程中,会出现立即增强效应或延迟反弹效应。本文在介绍思维抑制研究范式发展脉络的基础上,分别从信息加工和动机视角对思维抑制的加工机制及其影响因素进行了梳理,并据此指出未来研究应改进研究范式,考察环境变量对思维抑制的影响,整合理论解释以及开发改善精神障碍患者思维抑制的训练方法。     

A comparison of thought suppression to an acceptance-based technique in the management of personal intrusive thoughts: a controlled evaluation

Research suggests that suppressing unwanted thoughts is not possible, leads to a subsequent increase in frequency of the suppressed thoughts, and results in higher levels of distress. Because thought suppression may have negative effects, an alternative, acceptance-based approach has been proposed. The current paper reports the outcomes of two studies. Study I examined the relationships between two naturally occurring strategies of thought management (thought suppression and acceptance), symptoms of psychopathology, and experiences with personally relevant intrusive thoughts. Results showed that those who naturally suppress personally relevant intrusive thoughts have more, are more distressed by, and have a greater "urge to do something" about the thoughts, while those who are naturally more accepting of their intrusive thoughts are less obsessional, have lower levels of depression, and are less anxious. Study II compared three groups (thought suppression, acceptance, and monitor-only groups) on the frequency and distress associated with experiencing personally relevant intrusive thoughts. Results revealed that those instructed to suppress their personal intrusive thoughts were unable to do so and experienced an increased level of distress after suppression, whereas those instructed to use an acceptance-based strategy experienced a decrease in discomfort level (but not thought frequency) after having used such a strategy. These data offer initial evidence that acceptance may be a useful alternative to the suppression of personally relevant intrusive 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.     

How to suppress obsessive thoughts

Thought suppression (i.e. consciously trying to avoid certain thoughts from entering consciousness) has been argued to be an inadequate strategy in case of unwanted intrusions. That is, thought suppression seems to result in more rather than less intrusions. Although this experimental finding has been explained in terms of failing attempts to distract oneself from the target thought, the White Bear Suppression Inventory (WBSI; a scale that measures chronic thought suppression tendencies) does not address the means by which respondents try to suppress unwanted thoughts. To examine which strategies of mental control people use to suppress unwanted thoughts, obsessive-compulsive disorder patients (N=47) completed the WBSI, the Thought Control Questionnaire, and two measures of psychopathology. Results suggest that the crucial mechanism in thought suppression may not be distraction, but self-punishment.     

Thought suppression in obsessive-compulsive disorder

Social cognition research has indicated that attempts to suppress thoughts can lead to a paradoxical increase in the frequency of that thought. This phenomenon has been a central component of cognitive-behavioural models of obsessive-compulsive disorder (OCD); however, research has yet to demonstrate deficient thought suppression ability in OCD patients. We examined whether individuals with OCD (OCs) exhibit a deficit in the ability to suppress thoughts. In Experiment 1, attempted thought suppression led to a paradoxical increase in self-reported thoughts for OCs, but not for nonanxious controls (NACs) or anxious controls (ACs). In order to rule out self-report biases, in Experiment 2 we utilized a lexical decision paradigm that measured priming strength of a target word under thought suppression conditions. Results paralleled those of Experiment 1: OCs showed decreased lexical decision latency of the 'suppressed' thought (thought to reflect either increased priming strength or disrupted processing of nonsuppressed thoughts), thus exhibiting a paradoxical effect of thought suppression. This effect was not seen in NACs or ACs. These findings suggest that deficits in cognitive inhibitory processes may underlie the intrusive, repetitive nature of clinical obsessions.     

Relationships between thought-action fusion, thought suppression and obsessive-compulsive symptoms: a structural equation modeling approach

Research has shown that there are strong similarities in content between the obsessions and compulsions that characterize obsessive-compulsive disorder and nonclinical obsessions and compulsions. However, clinical and nonclinical obsessions and compulsions do differ with respect to characteristics like frequency, intensity, discomfort and elicited resistance. Two separate concepts have been invoked to explain how normal obsessions and compulsions may develop into clinical phenomena. First, it is suggested that thought-action fusion (TAF) contributes to obsessive-compulsive symptoms. Second, thought suppression may intensify obsessive-compulsive symptoms due to its paradoxical effect on intrusive thoughts. Although both phenomena have been found to contribute to obsessive-compulsive symptoms, possible interactions between these two have never been investigated. The current study explored how TAF and thought suppression interact in the development of obsessive-compulsive symptoms. Undergraduate psychology students (N = 173) completed questionnaires pertaining to TAF, thought suppression and obsessive-compulsive symptoms. Covariances between the scores on these questionnaires were analyzed by means of structural equation modeling. Results suggest that TAF triggers thought suppression, while thought suppression, in turn, promotes obsessive-compulsive symptoms.     

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.     

Organization of the Self-Concept and the Suppression of Self-Relevant Thoughts

The rebound effect associated with thought suppression has been found following attempts at suppressing both novel stimuli and stereotypical thoughts. However, research examining the suppression of self-relevant thoughts has been less successful in demonstrating the rebound effect. A potential factor that has not yet been fully explored in research on thought suppression is how different types of distracter thoughts may influence the ability to suppress unwanted thoughts. One type of distracter that people may use while attempting to suppress unwanted self-relevant thoughts is information related to other aspects of their lives. To the extent that these other aspects are more likely to be associated in memory with the unwanted thoughts, rebound should be more likely to occur. Thus, we expected and found that people lower in self-complexity (i.e., those with fewer self-aspects that are more interrelated with one another) revealed greater rebound following thought suppression that involved self-relevant distracting thoughts than did people greater in self-complexity. Implications of these findings for thought suppression, self-complexity, depression, and the experience of affect are discussed.     

Origins of Ruminative Thought: Trauma, Incompleteness, Nondisclosure, and Suppression

The purpose of this paper is to discuss theories of the origin of ruminative thought. We begin by providing a working definition of rumination, separating rumination from other forms of cognitive activity and distinguishing ruminations from ordinary memories. Then, we review what we believe are the major categories of theory that attempt to account for the existence and nature of rumination. These include theories of traumatization, incompleteness, nondisclosure, and thought suppression. Ruminations may originate for a number of reasons, but it seems they may continue because of our attempts to control them. Evidence from studies on thought suppression suggests that the suppression of unwanted thoughts may in fact fuel the very emotions and thoughts we are trying to avoid. Thought suppression may set up a state in which we not only increase the amount we think about an unwanted thought, but potentially also sharpen our emotional reaction to those thoughts.     

Suppression of emotional and neutral material

Previous studies have indicated that suppression of a thought results in an immediate increase of the frequency of this thought and/or in a rebound effect, i.e. in a heightened frequency of this thought later on. The present study (n = 53) examined the relationship between suppression and emotionality of the to-be-suppressed material. More specifically, it was investigated whether suppression of an emotional story results in stronger immediate enhancement or thought rebounds than suppression of a neutral story. There was a clear initial enhancement effect in the group suppressing a neutral story: subjects who tried to suppress experienced more target thoughts than subjects who did not try to suppress. In the neutral-story conditions, no rebound effect occurred. In the groups exposed to an emotional story, there was neither evidence of initial enhancement nor of a rebound. As most obsessions are related to emotional themes, the present findings cast doubt on the claim that the rebound phenomenon represents a valid laboratory model for clinical obsessions.     

Assessing Emotion Regulation in Social Anxiety Disorder: The Emotion Regulation Interview

Social anxiety disorder (SAD) is thought to involve emotional hyper-reactivity and emotion dysregulation. However, the precise nature of the emotion dysregulation in SAD has not been well characterized. In the present study, the Emotion Regulation Interview (ERI) was developed to quantify the frequency and self-efficacy of five emotion regulation strategies specified by Gross’s (Review of General Psychology 2: 271–299, 1998) process model of emotion regulation. Forty-eight individuals with SAD and 33 healthy controls (HCs) were interviewed about responses during (a) a laboratory speech task and (b) two recent social anxiety-evoking situations. Individuals with SAD reported greater use of avoidance and expressive suppression than HCs, as well as lesser self-efficacy in implementing cognitive reappraisal and expressive suppression. These regulation deficits were not accounted for by differences in emotional reactivity. These findings highlight specific emotion regulation deficits in SAD, and support the idea that the Emotion Regulation Interview may be usefully applied to other clinical disorders.     

Mood-congruent thoughts and personality disorder pathology

The primary aim of this research was to investigate associations that depression severity and trait anxiety have with reactions to specific, identifiable thoughts experienced by persons with varying levels of personality disorder (PD) pathology as they went about their day-to-day lives. Ninety-eight psychotropic medication-free persons participated in an experience sampling assessment procedure over four consecutive days, during which participants recorded specific thoughts experienced moments before a page signal was received and corresponding ratings of thought discomfort. Thought discomfort, regarded as an emotional reaction to thoughts or their evaluation, was moderately associated with several forms of PD pathology, particularly Cluster C pathology. Once depression severity and trait anxiety were controlled, however, associations between PD pathology and thought discomfort were eliminated. Findings from this research generally support the mood-congruence of negatively valenced thoughts in relation to PD pathology.     

Clinical obsessions in obsessive-compulsive patients and obsession-relevant intrusive thoughts in non-clinical, depressed and anxious subjects: where are the differences?

Contemporary cognitive models of obsessive-compulsive disorder (OCD) assume that clinical obsessions evolve from some modalities of intrusive thoughts (ITs) that are experienced by the vast majority of the population. These approaches also consider that the differences between "abnormal" obsessions and "normal" ITs rely on quantitative parameters rather than qualitative. The present paper examines the frequency, contents, emotional impact, consequences, cognitive appraisals and control strategies associated with clinical obsessions in a group of 31 OCD patients compared with the obsession-relevant ITs in three control groups: 22 depressed patients, 31 non-obsessive anxious patients, and 30 non-clinical community subjects. Between-group differences indicated that the ITs frequency, the unpleasantness and uncontrollability of having the IT, and the avoidance of thought triggers obtained the highest effect sizes, and they were specific to OCD patients. Moreover, two dysfunctional appraisals (worry that the thought will come true, and the importance of controlling thoughts) were specific to OCD patients. The OCD and depressed patients shared some dysfunctional appraisals about their most disturbing obsession or IT (guilt, unacceptability, likelihood thought would come true, danger, and responsibility for having the IT), whereas the non-obsessive anxious were nearer to the non-clinical participants than to the other two groups of patients. The OCD patients showed an increased use of thought control strategies, with overt neutralizing, thought suppression, and searching for reassurance being highly specific to this group.     

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.     

Why did the white bear return? Obsessive-compulsive symptoms and attributions for unsuccessful thought suppression

The current study examined the nature and consequences of attributions about unsuccessful thought suppression. Undergraduate students with either high (n=67) or low (n=59) levels of obsessive–compulsive symptoms rated attributions to explain their unsuccessful thought suppression attempts. We expected that self-blaming attributions and attributions ascribing importance to unwanted thoughts would predict more distress and greater recurrence of thoughts during time spent monitoring or suppressing unwanted thoughts. Further, we expected that these attributions would mediate the relationship between obsessive–compulsive symptom levels and the negative thought suppression outcomes (distress and thought recurrence). Structural equation models largely confirmed the hypotheses, suggesting that attributions may be an important factor in explaining the consequences of thought suppression. Implications are discussed for cognitive theories of obsessive–compulsive disorder and thought suppression.     

Personally relevant intrusions outside the laboratory: Long-term suppression increases intrusion

It has been suggested that the suppression of unwanted thoughts may increase their frequency and that this effect may contribute to some psychological problems. Previous studies have examined this over a period of minutes, in an artificial setting. Suppression over a four day period was evaluated in the present study. Each S was asked to identify a negative intrusive thought which he or she experienced and to record each occurrence of it in conditions designed to maximise the similarity to those experienced by obsessional patients. Ss were randomly allocated to one of three groups. One group was asked to suppress their thoughts whenever they occurred, another group was asked to think about their thoughts whenever they occurred and the third group just recorded the thoughts whenever they occurred. This design allowed experimental control of both attention to and manipulation of the target thoughts in contrast to attention and active suppression. It was found that Ss who suppressed their thoughts experienced more thoughts and found them more uncomfortable than Ss in the other two groups. This is consistent with the theory that suppression increases thought frequency and may be important in the development and maintenance of some disorders.     

How to control a white bear? Individual differences involved in self-perceived and actual thought-suppression ability

Thought suppression is generally considered a maladaptive mental control strategy, leading to increased intrusions. In the experimental psychopathology literature, thought suppression is assigned a central role in anxiety and depression, disorders characterised by a high level of negative intrusive thoughts. We examined predictors of self-perceived and actual thought suppression ability in an undergraduate sample. It was found that self-perceived suppression ability was predicted by anxiety and depression scores, attentional control, and distraction strategies. Immediate and rebound effects of actual suppression were predicted by depression scores. Interestingly, higher levels of attentional control and distraction were related to more successful thought suppression on the questionnaires, yet were related to increased intrusions during suppression.     

Why distractors with need-supportive content can mitigate ironic effects of thought suppression

Thought suppression is a self-regulatory strategy commonly used to avoid unwanted thoughts although it can ironically make unwanted thoughts more intrusive and accessible. To reduce these ironic effects, it is important to explore mechanisms underlying effective suppression. The present study recruited 126 undergraduate students and examined the influence of distractor content on suppression outcomes by examining perceived satisfaction and immersion of distractors as mechanisms of effective suppression. Based on self-determination theory, we proposed that distractors associated with the satisfaction of the psychological need for autonomy would mitigate ironic effects of thought suppression because they would be perceived as satisfying and immersive. Results showed that need-supportive distractors reduced intrusion frequency because they were indeed perceived as more satisfying. Our findings also point towards the unique satisfying properties of distractors involving psychological need satisfaction because effects of single, pleasant and personally relevant distractors have been controlled for. Findings are discussed using Wegner’s (Psychological Review 101:34–52, 1994) theories of thought suppression and principles of self-determination theory.