Individual differences in the experience of depressive and anxious, intrusive thoughts

Cognitive—clinical theorists such as Beck have implicated various personality traits as vulnerability factors in the experience of negative, distressing cognitions. A cluster analysis, performed on the basis of Ss' responses to a questionnaire specially constructed to assess anxious and depressive thoughts for features such as frequency, sadness, worry, controllability and unacceptability, demonstrated individual differences in the experience of negative cognitions. These differences were associated with varying levels of trait anxiety, dysphoria and obsessionality. Further analysis revealed that trait anxiety and neuroticism were more strongly associated with depressive rather than anxious cognitions. Obsessional complaints evidenced minimal association with anxious thoughts, though a moderate correlation was obtained between the former and depressive self-statements. It is suggested that personality factors are influential in the experience of negative cognitions in a highly specific manner.     

Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with depressive, anxious and obsessional symptoms

The present study reports on the development and preliminary validation of a 52 item self-report instrument designed to assess intrusive thoughts, images and impulses that are similar to the aggressive, sexual and disease-related thinking characteristic of clinical obsessions. Two hundred and ninety-three students completed the Obsessive Intrusions Inventory (OII) as well as standard self-report measures of negative cognitions and obsessive, anxious and depressive symptoms. Regression analysis revealed that intrusive thinking was a significant and unique predictor of obsessional but not anxious or depressive symptoms. Furthermore, intrusive thinking showed a moderate correlation with anxious but not depressive cognitions. The results indicate that the intrusive thoughts assessed by the OII are distinct from other forms of negative thinking and may, in fact, constitute an analogue form of clinical obsessions in nonclinical populations.     

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.     

Strategies used with intrusive thoughts: a comparison of OCD patients with anxious and community controls

Models of intrusive thoughts attribute a key role to strategies used by people to cope with their unwanted cognitions. In an extension of previous work, the authors conducted structured interviews with 38 people with obsessive-compulsive disorder, 38 people with another anxiety disorder, and 19 healthy volunteers. The interview identified the repertoire of strategies used with the participant's most troubling thought. The 2 clinical groups reported significantly more strategies than the nonclinical group. The clinical groups also reported significantly greater intensity of the thought and their emotional response and lower efficacy for the strategies. People with OCD reported a significantly higher proportion of strategies that were specifically linked to the thought content (as distinct from nonspecific strategies that were only linked sequentially in time). The results identify both common and differential characteristics of intrusive cognition in anxiety disorders.     

Adolescent dress, Part I: Dress and body markings of psychiatric outpatients and inpatients

This paper investigated the dress and body markings of 100 adolescent psychiatric patients (both hospitalized and never-hospitalized). Data were obtained from in-depth interviews conducted by a child psychiatrist. In contrast to nonhospitalized patients, hospitalized patients had a higher incidence of self-scarring, i.e., marks applied to self, either as a self-mutilation/suicide gesture or serving another purpose (for example, carving a boyfriend's initials into one's arm). Other individual expressions of appearance did not differentiate hospitalized from nonhospitalized patients. Detailed dress and appearance observations, questionnaires, photo reviews, self-portraits, and family discussions contributed to the beneficial effect of psychotherapy by focusing on feelings evoked and symbolized in dress and body markings.     

Anxiety sensitivity as a specific and unique marker of anxious symptoms in youth psychiatric inpatients

We addressed several questions regarding the relation of anxiety sensitivity to anxious symptoms among 47 youth psychiatric inpatients (18 boys, 29 girls), ages 9–17 (M = 14.23, SD = 1.89). Participants completed measures of anxiety sensitivity, anxious and depressive symptoms, trait anxiety, and positive and negative affect; chart diagnoses were available. Consistent with hypotheses, we found that (a) anxiety sensitivity was associated with anxious symptoms, even controlling for trait anxiety and depressive symptoms; and (b) anxiety sensitivity displayed symptom specificity to anxious versus depressive symptoms (i.e., was associated with anxiety controlling for depression but not with depression controlling for anxiety). Furthermore, regarding factors of anxiety sensitivity, we obtained mixed support for our prediction that phrenophobia would be associated with both depression and anxiety, whereas fear of physical arousal would be associated with anxiety but not depression. Implications for the construct validity of anxiety sensitivity were discussed.     

Differentiating cognitive content between depressed and anxious outpatients

Quantitative research suggests that depressed and anxious patients can be differentiated based on their cognitive content. This study used qualitative research methods to separate the specific components of open-ended depressive and anxious thought content in 79 psychiatric outpatients. Patients with major depressive disorder (MDD; n = 36), generalized anxiety disorder (GAD; n = 10), and other psychiatric disorders (PC; n = 33) were instructed to (a) describe their most bothersome problem; (b) imagine the worst possible negative outcome followed by the best possible positive outcome; and (c) describe associated thoughts and emotions for each scenario. The content of patients' responses were coded to examine (a) the types and severity of problems; (b) the presence or absence of hopelessness, catastrophizing, hopefulness, and unrealistic positive expectations; and (c) the presence or absence of particular emotions associated with imagined worst and best outcomes. More GAD patients than MDD and PC patients indicated anticipated anxious emotions associated with imagined worst outcomes, and fewer MDD patients than GAD and PC patients indicated anticipated happiness associated with imagined best outcomes. No group differences emerged for the other variables considered. These findings suggest that depressed and anxious patients differ in their cognitive expectancies about future life events in terms of their own anticipated emotional reactions.     

Preliminary examination of sex differences in depressive symptoms among adolescent psychiatric inpatients: the role of anxious symptoms and generalized negative affect.

Assessed the emerging view that generalized negative affect and anxious symptoms are important in understanding sex differences in depressive symptoms. Sixty-three adolescent psychiatric inpatients (32 boys, 31 girls), ages 12 to 16 (M = 13.87, SD = 1.36), completed measures of positive and negative affect and anxious and depressive symptoms. Results demonstrated, as predicted, that depressive and anxious symptoms were more highly associated in adolescent girls than boys. Furthermore, girls with depressive symptoms were more likely to have comorbid anxious symptoms than boys with depressive symptoms. Sex differences were not found for adolescents with specific depressive symptoms and specific anxious symptoms (i.e., the absence of comorbidity). Our findings supported the possibility that sex differences in pure forms of depression are overestimated and that comorbid internalizing conditions may be more prevalent in adolescent girls than boys.     

Process characteristics of worry and obsessive intrusive thoughts

One hundred and twenty-five university students were administered a battery of self-report measures to assess worry disposition and content, frequency of obsessive intrusive thoughts, and 10 conceptually derived appraisal dimensions of worry and obsessional intrusions. Process ratings indicated that the worrisome thoughts were considered more disturbing than the ego-dystonic intrusive thoughts. Worry was also distinguished by a focus on the possible consequences of negative events, whereas concern about the personal meaning of the thought was a unique process dimension for obsessive intrusive thoughts. Both content and process variables are important in differentiating worry and obsessive-like intrusive thoughts in a nonclinical population.     

Substance use among Iranian psychiatric inpatients.

This study evaluated substance use among a sample of 205 psychiatric inpatients (70 women and 135 men) chosen randomly. The subjects (who had schizophrenia or mood disorders) were evaluated on a confidential questionnaire by interview. Their mean age was 35 yr. (SD= 10.4, range 16 to 69). Of these participants, 76% of the 135 men and 34% of the 70 women admitted use of substances: cigarettes (74% of men, 31.4% of women), opiates (31.9% of men, 4.3% of women), alcohol (23.7% of men, 4.3% of women), hashish (8.9% of men, no women), marijuana (3.7% of men, no women), and cocaine or LSD by none. Only 27% of the women and 63% of the men reported still using substances regularly; some reported using more than one substance. Of the current users, 61.8% of the schizophrenics, 20% of unipolar depressed, and 37.5% of bipolar patients reported current use. The reasons for substance use in order of frequencies of mention were release of tension, seeking pleasure, and need (to avoid withdrawal symptoms) by men and habit, seeking pleasure, and need by women.     

Unsuccessful suppression is associated with increased neuroticism,intrusive thoughts,and rumination

Studies of thought suppression, the reduction in accessibility for intentionally unrehearsed and actively avoided thoughts, vary dramatically in the level of suppression reported. The purpose of our research was to explore individual differences associated with self-reports of the success, failure, or avoidance of thought suppression in everyday life. Participants completed a survey measuring intrusive thoughts, neuroticism, rumination, and autobiographical knowledge of suppression tendencies and capabilities. Individuals who reported successful suppression were less neurotic, ruminative, and experienced less thought intrusion than individuals who reported unsuccessful suppression attempts. Our findings suggest that the high-ends of the neuroticism and intrusive thought spectrums are occupied by individuals who unsuccessfully attempt to suppress undesirable information, while successful suppressors differ minimally from non-suppressors.     

Rumination, reflection, intrusive thoughts, and hallucination-proneness: Towards a new model

Although rumination has been proposed to play an important role in the creation of hallucinations, direct empirical tests of this proposal have not yet been performed. Employing a distinction between ruminative and reflective self-consciousness, we set out to test a new model of the relations among rumination, reflection, intrusive thoughts, thought suppression, social anxiety, and hallucination-proneness. This model proposed that rumination would be related to hallucination-proneness through the mediating variable of intrusive thoughts, but that reflection would not be related to hallucination-proneness. The model was tested in a student population (N = 296) using path analyses. A modified version of the model was found to be a good fit to the data, once a direct path from reflection to hallucination-proneness had been added. As hypothesized, rumination was related to hallucination-proneness only indirectly, through the mediating variable of intrusive thoughts. Implications for interventions and future directions for research are considered.     

MMPI validity scales and behavioral disturbance in psychiatric inpatients.

Sixty psychiatric inpatients were assigned to one of three groups on the basis of F and K MMPI validity scales. Staff ratings of patient behavior and recorded incidents of "acting-out" behavior were obtained for patients with: (a) "plea for help" validity profiles, (b) hyper-defensive profiles, and (c) average profiles. Patients with "plea for help" profiles were perceived as "acting-out" more frequently and engendering more feelings of frustration than patients in the other groups. These patients account for 77% of the incidents of inappropriate, destructive behavior and 83% of the seclusions in the patients sampled. Although the "plea for help" profile is considered invalid in some scoring systems, results suggest that this validity profile may be useful in treatment planning.     

Neuropsychological performance and suicidal behavior in adult psychiatric inpatients.

Although various studies have shown that suicidal persons exhibit greater cognitive deficiencies than both normals and other psychiatric patients, researchers as yet have been unable to account for the source(s) of the differences. Some of these differences (e.g., cognitive rigidity and impaired problem solving) hint of possible organic involvement. This study explored the relationship of neuropsychological functioning to suicidal behavior by comparing 20 suicidal and 27 nonsuicidal psychiatric inpatients on several tests of neuropsychological functioning. Although results showed no significant differences between the two groups on most measures, both groups showed evidence of notably high levels of cortical dysfunction relative to test norms. Thirty-five percent of suicidal patients and 44% of nonsuicidal patients scored in the impaired range. Implications of this high frequency of impairment for the treatment of suicidal and nonsuicidal psychiatric patients are discussed.     

Self-esteem and interpersonal functioning in psychiatric outpatients

This study explored associations between self-esteem and interpersonal functioning in a one-year clinic cohort of psychiatric outpatients ( n = 338). At intake, patients completed questionnaires measuring self-esteem, interpersonal problems, interpersonal style, and general symptomatic distress. They were also diagnosed according to the ICD-10. Interpersonal behaviour was measured along the agency and communion dimensions of the Inventory of Interpersonal Problems – Circumplex [IIP-C]. The results show that lower self-esteem was associated with higher levels of interpersonal problems in general. Further, lower self-esteem was first and foremost linked to frustrated agentic motives, as measured by the IIP-C. Hence, the study concludes that fostering patient agency should be considered as an important goal in psychotherapy. Furthermore, the analyses revealed an interaction effect of agency and communion on self-esteem, indicating a need for balancing the two motive dimensions. Finally, some questions are raised concerning the interpretation of the IIP-C subscales in general.     

Distress and recurrence of intrusive thoughts in younger and older adults

The current study incorporated a life span perspective into existing theories of intrusive thoughts to examine age-related differences in the difficulty controlling intrusive thoughts, the distress following intrusive thought recurrences, and the meanings assigned to these recurrences. Younger (N = 51) and older (N = 49) community adults were randomly assigned to suppress (i.e., keep out of mind) or monitor an intrusive thought. Participants rated their positive and negative affect throughout engagement with the intrusive thought, and they also rated the meanings they gave to recurrences of their everyday intrusive thoughts. The results demonstrated that older adults tended to perceive greater difficulty with controlling the intrusive thought than younger adults despite the fact that they did not differ in the actual recurrence of the intrusive thought. With regard to distress, older adults experienced steadier levels of positive affect than younger adults throughout engagement with the intrusive thought. However, older adults also reported greater residual negative affect after engaging with the intrusive thought than younger adults. Finally, older and younger adults appeared to assign meanings to recurrences of intrusive thoughts in line with age-relevant concerns. Specifically, older adults were prone to interpret the recurrence of intrusive thoughts as a sign of cognitive decline, but they were less likely than younger adults to see intrusive thoughts as a sign of moral failure. Together, these results highlight a range of potential risk and protective factors in older adults for experiencing emotion dysregulation after intrusive thoughts.     

Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems

Jakes' critique fails to consider (i) the importance of appraisal of responsibility in initiating neutralising activity, and that (ii) obsessional patients negatively evaluate the occurrence as well as the content of intrusive thoughts. These factors are crucial because neutralising is presumed to be central to the development and maintenance of obsessional disorders. The current form of the hypothesis is outlined and recent data reviewed. Possible experimental investigations on the focus of therapeutic interventions are considered.     

Suppression of intrusive thoughts and working memory capacity in repressive coping

Previous research using a thought suppression paradigm found that repressors are more skilled in suppressing anxious autobiographical thoughts than low anxious, high anxious, and defensive high anxious people. Another line of research showed that individual differences in working memory capacity are related to the ability to intentionally suppress intrusive thoughts. This study aimed at combining these findings and sought to investigate whether repressors' superior ability to suppress intrusive thoughts is related to a larger working memory capacity. Results indicate that in a thought suppression paradigm, repressors report fewer intrusive thoughts for their most anxious experiences than participants in the 3 other subgroups. Furthermore, the superior ability of repressors to avoid intrusive thoughts can be explained largely by their higher working memory capacity.