Gender differences in health anxiety: An investigation of the interpersonal model of health anxiety

Health anxiety (HA) involves persistent worry about one’s health and beliefs one has an illness or may contract a disease. In the present study, gender differences in Noyes et al.’s (2003) interpersonal model of health anxiety (IMHA) were examined. Using a sample of 950 undergraduates (674 women; 276 men), multigroup confirmatory factor analyses suggested the measurement model for key dimensions of the IMHA (i.e., reassurance-seeking, alienation, worry, and absorption) were invariant across gender. This suggests key dimensions of this model are applicable to and generalizable across women and men. Coefficients alpha for and bivariate correlations between these IMHA dimensions were also roughly comparable across women and men. As hypothesized, mean levels of reassurance-seeking and worry were significantly higher in women compared to men. No gender differences were observed in mean levels of alienation or absorption. Reassurance-seeking and worry appear salient in the interpersonal behavior and emotional life of women with HA. The present study helps to clarify gender differences in the IMHA and other HA models involving similar variables.     

The effects of safety behaviors on health anxiety: an experimental investigation

The present study examined the extent to which safety behaviors exacerbate symptoms of hypochondriasis (severe health anxiety). Participants were randomized into a safety behavior (n = 30) or control condition (n = 30). After a baseline period, participants in the safety behavior condition spent one week actively engaging in a clinically representative array of health-related safety behaviors on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of safety behaviors. Compared to control participants, those in the safety behavior condition reported significantly greater increases in health anxiety, hypochondriacal beliefs, contamination fear, and avoidant responses to health-related behavioral tasks after the safety behavior manipulation. In contrast, general anxiety symptoms did not significantly differ between the two groups as a function of the manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related thoughts mediated the effects of the experimental manipulation on health anxiety. These findings suggest that safety behaviors are associated with increases in health anxiety, perhaps by fostering catastrophic thoughts about health. The implications of these findings for the conceptualization of hypochondriasis as an anxiety disorder are discussed.     

Test anxiety,emotional responding under guided imagery,and self-talk during an academic examination

Abstract

This investigation examined the assumption that phenomenological responses created by guidedimagery procedures pertinent to test anxiety are topographically similar to emotional responses experienced during an actual examination. Participants were divided on facilitating versus debilitating test anxiety and exposed to subclinical doses of stimulus-response propositions that involved test-taking, fear, and physical activity using the induction technique employed by Lang et al. (1980). Patterns of emotional responses obtained after each induction were compared to the pattern elicited immediately prior to students' final course examination as well as self-talk during the examination. Results indicated that exposure to test-related imagery elicited a pattern of emotional responding that was different than exposure to fear or action imagery but was nearly identical to emotional responses found before examinations. Negative emotional states before the examination also were associated with higher frequencies of negative self-statements during the examination. Treatment implications of these findings were explored.     

Rumination and self-defining memories in the context of health concerns

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.     

Retrieval properties of negative vs. positive mental images and autobiographical memories in social anxiety: outcomes with a new measure

High (n = 41) and low (n = 39) socially anxious (SA) participants completed the Waterloo Images and Memories Interview (WIMI), a new assessment tool that measures the accessibility and properties of mental images and associated autobiographical memories that individuals may experience across both anxiety-provoking (negative) and non-anxiety-provoking (positive) social situations. Results indicated that both high and low SA individuals experience negative images and associated autobiographical memories in anxiety-provoking social situations, but the rates of endorsement of such images and memories among high SA participants were substantially lower than those reported in recent studies. Moreover, whereas low SA individuals were capable of accessing a relatively balanced array of both negative and positive self-representations that were rich in episodic detail, high SA individuals retrieved a higher, more unbalanced ratio of negative-to-positive images and memories, as well as impoverished positive images that were significantly degraded in episodic detail. Finally, negative images influenced the two groups differently, with high SA individuals experiencing more negative emotional and cognitive consequences associated with bringing such images to mind. These results are discussed in relation to theoretical models of learning and memory within the context of contemporary cognitive behavioral models of social anxiety.     

Prevalence and treatment of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and co-morbid severe health anxiety

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a debilitating condition that affects 0.2–0.4% of the population. Health focussed anxiety is common across medical conditions, and may be relevant in CFS/ME. This study sought to identify the prevalence and impact of health anxiety (HA) in CFS/ME and evaluate the effectiveness of Cognitive Behavioural Therapy for HA in CFS/ME. Cross-sectional questionnaire methods and case-series design were used to achieve study aims. Analysis indicated that 41.9% of the CFS/ME clinic sample experienced threshold levels of health anxiety, which was associated with elevated symptom severity across several dimensions. Stepwise multiple regression indicated physical functioning and depression accounted for 23.8% of variance in fatigue; depression, fatigue and HA, accounted for 32.9% of variance in physical functioning. Large effect sizes and clinically significant changes were generated in the treatment study. HA is common in CFS/ME and likely to exacerbate fatigue and physical functioning. This study identifies HA as an important target for treatment, trial findings should be further replicated on a larger scale.     

Recurrent involuntary imagery in people who stutter and people who do not stutter

Objective

To compare intrusive memories in groups of people who do (PWS), and who do not (PWNS), stutter.

Method

Twenty-one participants who stuttered and 21 matched controls were given a semi-structured interview which explored imagery in speaking situations. The data were analyzed using a Content Analysis approach. Other outcome measures were the Beck Anxiety Inventory, the Beck Depression Inventory, the Post Traumatic Stress Disorder, PTSD, Symptom Scale: Self-Report Version.

Results

Significantly more stuttering participants than control participants indicated both recurrent imagery and associated memories. Content Analysis revealed themes of disfluency, anxiety, negative social evaluation, self-focus and pressure to speak that were common to both groups’ reports. Additional themes of helplessness, shame, sadness and frustration were found only in the images and memories of the stuttering group. No group differences were evident for the number of sensory modalities involved in images and memories, or for ratings of their vividness or strength of associated emotions, or on self-reports of depression, anxiety and trauma.

Conclusions

Recurrent imagery about events in childhood is a potent factor in the memories of PWS. It is worth modifying interventions that have been successfully applied for treating social anxiety for use with people who stutter.Educational objectives: After reading this article, participants will be able to: (a) identify the role of intrusive memories in psychiatric disorders and stuttering; (b) investigate how DSM criteria can be employed with people who stutter; (c) employ anxiety instruments used for assessing psychiatric disorders for stuttering; (d) distinguish between the intrusive memories experienced by people who stutter, and people who do not stutter; (e) apply treatments for intrusive memories in psychiatric disorders to work with people who stutter.     

Dynamic locomotor imagery in athletes with severe visual impairments

Motor imagery is a mental process not accompanied by movement and widely studied in healthy subjects, related to hand movements in terms of timing. This study compared static and dynamic motor imagery analyzing temporal and spatial features in different locomotor conditions in three different groups of subjects: high-skilled athletes with visual impairments, a group of sighted unprofessional athletes and a control group of sighted subjects. We found that dynamic motor imagery resulted in timely closer to real performance than static motor imagery. The discrepancies between dynamic motor imagery and real condition, in fact, resulted limited to uncommon locomotion, such as lateral walking. Motor imagery resulted closer to real performance in terms of timing than in terms of step length, with the exception of athletes with visual impairments that, differently from the other groups, did not show any significant differences between the numbers of imagined and performed steps. It opens a new question about the relationship between temporal and spatial imagination of locomotion.     

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.     

Intrusive thoughts in patients with obsessive compulsive disorder and non-clinical participants: a comparison using the International Intrusive Thought Interview Schedule

The International Intrusive Thought Interview Schedule (IITIS) was used to assess and compare the unwanted intrusive thoughts (UITs) reported in a group of patients with obsessive compulsive disorder (OCD) and a non-clinical group. Although all participants reported at least one type of intrusion, OCD patients experienced more intrusive thoughts than non-clinical participants, and this difference was statistically significant. In the OCD group, intrusive thoughts were more frequent, interfered more with daily life, were considered to be more important to get out of the mind, and were more difficult to stop than in non-clinical participants. The two groups did not differ significantly in terms of five appraisals of the most distressing intrusive thought. One appraisal (importance) was used far more by the OCD group than the non-clinical group. For three appraisals (intolerance of anxiety, need to control, and intolerance of uncertainty), the difference was smaller. Only two of the strategies for controlling the most upsetting intrusive thought (ritual and avoidance) were of value in differentiating between the two groups. The IITIS (an instrument used to assess intrusions in non-clinical samples) appears to be of value for the assessment of patients with OCD.     

Anxiety sensitivity and intolerance of uncertainty: Evidence of incremental specificity in relation to health anxiety

Anxiety sensitivity (AS) reflects the fear of arousal-related sensations and intolerance of uncertainty (IU) represents the dispositional fear of the unknown. Within cognitive–behavioral models, AS and IU are individual difference variables considered central to the phenomenology of health anxiety. However, prior studies have cast doubt on whether both variables incrementally contribute to our understanding of health anxiety. Addressing limitations of these prior studies, the present study examined the incremental specificity of AS and IU as these two variables relate to health anxiety in a large medically healthy sample of community adults (N = 474). Both AS and IU incrementally contributed to the concurrent prediction of health anxiety beyond both negative affect and one another. However, within these analyses, the physical dimension of AS and the inhibitory dimension of IU were the only AS and IU dimensions to evidence incremental specificity in relation to health anxiety.     

Intrusive and non-intrusive memories in a non-clinical sample: the effects of mood and affect on imagery vividness

We studied the number, valence, and vividness of intrusive and non-intrusive memories in two groups (N = 20) of pre-screened non-depressed mood and depressed mood undergraduate participants. They were asked to generate as many intrusive memories (IMs) as possible from the prior 2 weeks, together with pleasant and unpleasant non-intrusive memories from the same period. They subsequently formed images of these memories and rated them on measures of vividness, valence, arousal, and overall affect, while having their heart rate, skin conductance, and electromyogram monitored. IMs were common, with participants generating a mean of 1.15 pleasant IMs and 1.60 unpleasant IMs, and there was some evidence that they were mood-congruent. IMs were more vivid than non-intrusive memories, a difference not due to either valence or arousal. We conclude that IMs are a general feature of human memory rather than just a symptom of certain clinical disorders.     

Direct and generative retrieval of autobiographical memories: The roles of visual imagery and executive processes

Two experiments used a dual task methodology to investigate the role of visual imagery and executive resources in the retrieval of specific autobiographical memories. In Experiment 1, dynamic visual noise led to a reduction in the number of specific memories retrieved in response to both high and low imageability cues, but did not affect retrieval times. In Experiment 2, irrelevant pictures reduced the number of specific memories but only in response to low imageability cues. Irrelevant pictures also increased response times to both high and low imageability cues. The findings are in line with previous work suggesting that disrupting executive resources may impair generative, but not direct, retrieval of autobiographical memories. In contrast, visual distractor tasks appear to impair access to specific autobiographical memories via both the direct and generative retrieval routes, thereby highlighting the potential role of visual imagery in both pathways.     

Differences in negative life events between patients with anxiety disorders,depression and hypochondriasis

This study investigated whether some categories of adverse life events are differentially associated with specific types of emotional disorders. A life self-report measure of major life events was completed by 42 subjects with diagnoses of anxiety disorders, 46 subjects with major depression, 26 subjects with hypochondriasis and 73 nonclinical subjects (controls). As predicted, the onset of anxiety disorders, depression, and hypochondriasis appears to be differentially related with life stress of ‘threat’, ‘loss’, and ‘health’, respectively, previously experienced by the clinical subjects. Also, there were significant differences between clinical and nonclinical subjects on both perceived life stress and number of life events reported. Findings suggest a differential implication of psychosocial stress categories in particular emotional disorders (i.e., anxiety, depressive and hypochondriacal disorders). These results expand previous findings that have demonstrated an association between negative life events and psychopathology.     

Predictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety

Internet-based cognitive behavior therapy (CBT) for severe health anxiety can be effective, but not all patients achieve full remission. Under these circumstances, knowledge about predictors is essential for the clinician in order to make reliable treatment recommendations. The primary aim of this study was to investigate clinical, demographic, and therapy process-related predictors of Internet-based CBT for severe health anxiety. We performed three types of analyses on data from a sample comprising participants (N = 81) who had received Internet-based CBT in a randomized controlled trial. Outcomes were a) end state health anxiety, b) improvement in health anxiety (continuous change scores), and c) clinically significant improvement. Outcomes were assessed at six-month follow-up. The results showed that the most stable predictors of both end state health anxiety and improvement were baseline health anxiety and depressive symptoms. Treatment adherence, i.e. the number of completed treatment modules, also significantly predicted outcome. Notably, health anxiety at baseline was positively associated with symptom improvement while depressive symptoms was negatively related to improvement. Demographic factors were largely without significant impact on end state symptoms or improvement. We conclude that baseline symptom burden and adherence to treatment have strong predictive effects in Internet-based CBT for severe health anxiety.     

Increased use of safety-seeking behaviors in chronic back pain patients with high health anxiety

Many patients with chronic pain also exhibit elevated levels of health anxiety. This study examined the effect of health anxiety on the use of safety-seeking behaviors (SSBs) in pain-provoking situations. Participants were 20 chronic back pain patients with high health anxiety (Group H), 20 with low health anxiety (Group L) and 20 pain-free controls (Group C). Two physical tasks were video recorded, and compared both for overt pain behavior (identified by blind observers following a standardized procedure) and for the occurrence of SSB (identified by showing the participants video playback and asking them to specify motivation for all actions/behaviors displayed during the tasks). While there were no differences in the display of overt pain behaviors, Group H deployed a greater number of SSBs than Groups L and C. This finding held true for both tasks and remained significant when concurrent pain and mood ratings were statistically controlled for. SSB was correlated with catastrophizing thoughts but not pain intensity; pain intensity was correlated with overt pain behavior but not catastrophizing. Taken together, these findings suggest that SSB is distinct from overt pain behavior and may be a defining characteristic of chronic pain patients reporting high levels of health anxiety.     

Intrusive images in PTSD and in traumatised and non-traumatised depressed patients: a cross-sectional clinical study

Although intrusive images are a hallmark of post-traumatic stress disorder (PTSD) and also occur in depression, little is known about the differences and similarities of such images in these conditions. Our study focuses on the qualities and triggers of intrusive images and responses to them in three groups--patients with PTSD, and depressed patients with and without trauma (n=65)-to highlight the diagnostic specificity of intrusive images for PTSD and depression. We distinguished intrusive images from verbal intrusive cognitions such as rumination and intrusive (brief) lexical thoughts. Consistent with the literature, the intrusive images of PTSD patients had a more "here-and-now quality" and were perceived more visually compared to those of both depressed groups. The groups showed a good deal of similarity concerning other image qualities. Most importantly, the intrusive images in PTSD and depressed patients with and without trauma were perceived as similarly distressing. Rumination and intrusive (brief) lexical thoughts were two of the five most named triggers of intrusive images. Limitations, such as the lack of a control group, and the clinical implications of these results are discussed, demonstrating the need to help non-PTSD patients with and without trauma to deal with intrusive images.     

The health preoccupation diagnostic interview: inter-rater reliability of a structured interview for diagnostic assessment of DSM-5 somatic symptom disorder and illness anxiety disorder

Somatic symptom disorder (SSD) and illness anxiety disorder (IAD) are two new diagnoses introduced in the DSM-5. There is a need for reliable instruments to facilitate the assessment of these disorders. We therefore developed a structured diagnostic interview, the Health Preoccupation Diagnostic Interview (HPDI), which we hypothesized would reliably differentiate between SSD, IAD, and no diagnosis. Persons with clinically significant health anxiety (n = 52) and healthy controls (n = 52) were interviewed using the HPDI. Diagnoses were then compared with those made by an independent assessor, who listened to audio recordings of the interviews. Ratings generally indicated moderate to almost perfect inter-rater agreement, as illustrated by an overall Cohen’s κ of .85. Disagreements primarily concerned (a) the severity of somatic symptoms, (b) the differential diagnosis of panic disorder, and (c) SSD specifiers. We conclude that the HPDI can be used to reliably diagnose DSM-5 SSD and IAD.