Selective effects of excessive engagement in health-related behaviours on disgust propensity

The present study examined the extent to which engagement in health-related behaviours modulate disgust propensity, a purportedly stable personality trait. Participants were randomised into a health behaviour (n = 30) or control condition (n = 30). After a baseline period, participants in the health behaviour condition spent one week actively engaging in a clinically representative array of health-related behaviours on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of health behaviours. Compared to control participants, those in the health behaviour condition reported significantly greater increases in disgust propensity after the health behaviour manipulation. This effect was most robust for contamination disgust propensity and remained significant when controlling for changes in health anxiety and disease fear. In contrast, self-disgust and anxiety sensitivity did not significantly differ between the two groups as a function of the health behaviour manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related behaviours, but not changes in health anxiety and disease fear, mediated the effects of the experimental manipulation on changes in contamination disgust propensity. These findings suggest that the purportedly stable personality trait of disgust propensity can be modulated by excessive engagement in health-related behaviours.     

Safety behaviors were associated with greater anxious symptoms during the first year of the COVID-19 pandemic

Research shows that people who use safety behaviors are at greater risk factor for anxiety than people who do not use safety behaviors. However, the perception of some safety behaviors changed during the COVID-19 pandemic; behaviors that were once considered unnecessary or excessive were now commonplace (e.g., monitoring bodily symptoms, avoiding crowds). The purpose of this study was to determine the degree to which the pandemic changed the status of health-related safety behaviors as a risk factor for symptoms of anxiety. To this end, we tested the effect of safety behavior use on anxious symptoms during the first year of the pandemic using a longitudinal design with 8 time points and participants (n = 233) from over 20 countries. Despite possible changes in their perception, those engaging in high levels of safety behaviors reported the greatest levels of anxious symptoms throughout the pandemic year. However, the outcomes for safety behavior users were not all negative. Safety behavior use at baseline was the only predictor of participants' willingness to receive the COVID-19 vaccine (measured one year later).     

The effects of safety behaviors on the fear of contamination: an experimental investigation

The strategies used by anxious individuals to prevent feared outcomes, known as safety behaviors, are thought to maintain pathological anxiety by preventing the disconfirmation of inaccurate threat beliefs. However, it is possible that safety behaviors might also contribute to the development and exacerbation of anxiety symptoms. The present study tested this notion in a sample of undergraduate participants with either low (n=30) or high (n=26) levels of contamination fear. After a week-long baseline period, participants spent 1 week engaging in a clinically representative array of contamination-related safety behaviors on a daily basis, followed by a second baseline period. Subsequent to the safety behavior manipulation, participants evidenced statistically significant increases in threat overestimation, contamination fear symptoms, and emotional and avoidant responses to three contamination-related behavioral avoidance tasks (BATs). In contrast, anxiety and depressive symptoms remained stable. The magnitude of change in contamination concerns was equivalent among participants in both contamination fear groups. Our findings suggest that contamination-related safety behaviors elicit a modest and specific increase in the fear of contamination. Possible mechanisms for this effect, as well as implications for the role of safety behaviors in the psychopathology of anxiety disorders, are discussed.     

To see ourselves as others see us: an experimental integration of the intra and interpersonal consequences of self-protection in social anxiety disorder

The current study investigated the mechanism through which safety behaviors perpetuate perceived and actual negative social outcomes hypothesized to maintain social anxiety disorder (SAD). Eighty individuals diagnosed with generalized SAD took part in a "getting acquainted" conversation with a trained experimental confederate. Participants were then randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition and completed a 2nd conversation with the same interaction partner. Mediation analyses revealed that participants instructed to reduce their idiosyncratic safety behaviors displayed significantly greater increases in both perceived and actual positive interpersonal outcomes relative to the EXP group. However, whereas the safety behavior manipulation influenced participants' appraisals of their partner's reaction to them through reducing self-judgments about the visibility of anxiety-related behaviors, in reality, the SB + EXP group elicited more positive partner reactions because they displayed a greater increase in social approach behavior. Thus, although both parties recognized positive changes in the social exchange following the safety behavior manipulation, different sources of social information accounted for participant versus partner interpersonal judgments. The current findings point to the potential value of considering both the intra and interpersonal consequences of safety behaviors in SAD.     

Self-focused attention and safety behaviors across group therapies for social anxiety disorder

Background: Self-focused attention (SFA) and safety behaviors are two variables implicated in the maintenance of social anxiety disorder (SAD).

Design: The present study examined SFA and safety behaviors across two therapies for SAD, cognitive behavioral group therapy (CBGT) and mindfulness and acceptance-based group therapy (MAGT).

Method: Participants with symptoms meeting criteria for SAD (N?=?137) were randomly assigned to the 12-week-treatment groups (n?=?53 for each condition) or a waitlist control (n?=?31). Variables were assessed at baseline, midtreatment, posttreatment, and a 3-month follow-up.

Results: Both treatment conditions reported significantly lower SFA and safety behaviors compared to control, but did not differ from one another at posttreatment. Mediation analyses supported the following models: (1) safety behaviors mediating the relationship between SFA and social anxiety, and (2) SFA mediating the relationship between safety behaviors and social anxiety. These models were supported for both treatment groups.

Conclusions: Both treatments may have the potential to reduce the SFA and safety behaviors that serve to maintain SAD.     

Safety behaviors and judgmental biases in social anxiety disorder

Two experiments were conducted to examine the link between safety behaviors and social judgments in social anxiety disorder (SAD). Safety behaviors were manipulated in the context of a controlled laboratory-based social interaction, and subsequent effects of the manipulation on the social judgments of socially anxious participants (N = 50, Study 1) and individuals meeting diagnostic criteria for generalized SAD (N = 80, Study 2) were examined. Participants were randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition, and then took part in a conversation with a trained experimental confederate. Results revealed across both studies that participants in the SB + EXP group were less negative and more accurate in judgments of their performance following safety behavior reduction relative to EXP participants. Study 2 also demonstrated that participants in the SB + EXP group displayed lower judgments about the likelihood of negative outcomes in a subsequent social event compared to controls. Moreover, reduction in safety behaviors mediated change in participant self-judgments and future social predictions. The current findings are consistent with cognitive theories of anxiety, and support the causal role of safety behaviors in the persistence of negative social judgments in SAD.     

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

Computerized attention retraining for individuals with elevated health anxiety

Background and Objectives: Current cognitive-behavioral theorists conceptualize hypochondriasis as excessive health anxiety (HA). Growing evidence suggests that elevated HA is associated with attentional bias (AB) toward potential health-threat information. Design: This study aimed to examine the effects of attention retraining among individuals with elevated HA, using the established attention modification programs (AMP) designed to train participants to disengage attention from ideographically chosen health-threat words. Methods: Thirty-six randomly assigned individuals with elevated HA completed eight twice-weekly sessions of the AMP (n = 18) or the attention control condition (ACC; n = 18). Results: Despite using the well-established AMP protocol widely used within the field of anxiety disorders, we did not find evidence for change in AB following training. Further, AMP did not outperform ACC in reducing HA and other relevant emotional symptoms. However, both AMP and ACC evidenced overall significant symptom reduction in most of the outcome measures, including overall HA, anxiety sensitivity, general depression and anxiety, and somatic complaints. Conclusions: Further research is needed to better understand the effects and mechanisms of AMP as a possible cognitive intervention for HA.     

Modifying automatic approach action tendencies in individuals with elevated social anxiety symptoms

Research suggests that social anxiety is associated with a reduced approach orientation for positive social cues. In the current study we examined the effect of experimentally manipulating automatic approach action tendencies on the social behavior of individuals with elevated social anxiety symptoms. The experimental paradigm comprised a computerized Approach Avoidance Task (AAT) in which participants responded to pictures of faces conveying positive or neutral emotional expressions by pulling a joystick toward themselves (approach) or by moving it to the right (sideways control). Participants were randomly assigned to complete an AAT designed to increase approach tendencies for positive social cues by pulling these cues toward themselves on the majority of trials, or to a control condition in which there was no contingency between the arm movement direction and picture type. Following the manipulation, participants took part in a relationship-building task with a trained confederate. Results revealed that participants trained to approach positive stimuli displayed greater social approach behaviors during the social interaction and elicited more positive reactions from their partner compared to participants in the control group. These findings suggest that modifying automatic approach tendencies may facilitate engagement in the types of social approach behaviors that are important for relationship development.     

Retracted: Effects of cartoon violence on aggressive thoughts and aggressive behaviors

This article reports on an experiment designed to test whether the cartoon manipulation leads to significant increases in aggressive thoughts and aggressive behaviors among Chinese children (n = 3,000). Results indicated that brief exposure to a violent cartoon triggered higher aggressive thoughts and aggressive behaviors than a nonviolent cartoon. Females displayed higher aggressive thoughts and aggressive behaviors than males in a nonviolent cartoon condition, while males displayed higher aggressive behaviors than females in a violent cartoon condition. Mediation analysis suggested that the effect on aggressive behaviors was mediated by aggressive thoughts. The findings imply that cartoon developers, parents, and teachers should develop cartoons that inhibit children's aggressive thoughts to avoid aggressive behaviors. Females are the key group for the prevention and intervention of aggression in a nonviolent cartoon context, while males are the key group for the prevention and intervention of aggression in a violent cartoon context.     

Assessment of Implicit Health Attitudes: A Multitrait–Multimethod Approach and a Comparison Between Patients With Hypochondriasis and Patients With Anxiety Disorders

Two adaptations of the Implicit Association Task were used to assess implicit anxiety (IAT–Anxiety) and implicit health attitudes (IAT–Hypochondriasis) in patients with hypochondriasis (n = 58) and anxiety patients (n = 71). Explicit anxieties and health attitudes were assessed using questionnaires. The analysis of several multitrait–multimethod models indicated that the low correlation between explicit and implicit measures of health attitudes is due to the substantial methodological differences between the IAT and the self-report questionnaire. Patients with hypochondriasis displayed significantly more dysfunctional explicit and implicit health attitudes than anxiety patients, but no differences were found regarding explicit and implicit anxieties. The study demonstrates the specificity of explicit and implicit dysfunctional health attitudes among patients with hypochondriasis.     

Effects of safety behaviors on fear reduction during exposure

The use of safety behaviors has been considered one of the primary maintaining mechanisms of anxiety disorders; however, evidence suggests that they are not always detrimental to treatment success (Milosevic & Radomsky, 2008). This study examined the effects of safety behaviors on behavioral, cognitive, and subjective indicators of fear during exposure for fear of spiders. A two-stage design was used to examine fear reduction and approach distance during an in vivo exposure task for participants (N = 43) assigned to either a safety behavior use (SBU) or no safety behavior use (NSB) condition. Overall, both groups reported significant and comparable reductions in self-reported anxiety and negative beliefs about spiders at posttest and 1-week follow-up. Participants in the SBU group approached the spider more quickly than did participants in the NSB condition; however, participants in the SBU condition showed a small but significant decrease in approach distance at follow-up. These results call for a reconceptualization of the impact of safety behaviors on in vivo exposure.     

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.     

An Open Trial of Telephone-Delivered Mindfulness-Based Cognitive Therapy: Feasibility,Acceptability, and Preliminary Efficacy for Reducing Depressive Symptoms

Mindfulness-based cognitive therapy (MBCT) is a promising intervention for reducing depressive symptoms in individuals with comorbid chronic disease, but the program’s attendance demands make it inaccessible to many who might benefit. We tested the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered adaptation of the in-person mindfulness-based cognitive therapy (MBCT-T) program in a sample of patients with depressive symptoms and hypertension.Participants (n = 14; 78.6% female, mean age = 60.6) with mild to moderate depressive symptoms and hypertension participated in the 8-week MBCT-T program. Feasibility was indexed via session attendance and home-based practice completion. Acceptability was indexed via self-reported satisfaction scores. Safety was assessed via reports of symptomatic decline or need for additional mental health treatment. Depressive symptoms (Quick Inventory of Depressive Symptomatology–Self-Report [QIDS-SR]) and anxiety (Hospital Anxiety and Depression Scale—Anxiety subscale; HADS-A) were assessed at baseline and immediately following the intervention.Sixty-four percent of participants (n = 9) attended ≥4 intervention sessions. Seventy-one percent (n = 6) of participants reported completing all assigned formal home practice and 89.2% (n = 8) reported completing all assigned informal practice. Participants were either very satisfied (75%; n = 6) or mostly satisfied (25%; n = 2) with the intervention. There were no adverse events or additional need for mental health treatment. Depressive symptom scores were 4.09 points lower postintervention (p = .004). Anxiety scores were 3.18 points lower postintervention (p = .039).Results support the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered version of MBCT for reducing depressive and anxiety symptoms in individuals with co-occurring chronic disease.     

An experimental analysis of hypochondriasis

Hypochondriasis (HC) involves preoccupation with fears of having a serious medical illness based on the misinterpretation of benign bodily perturbations. Individuals with HC also perform behaviors such as checking and reassurance-seeking presumably to reduce health-related fears. Experimental behavioral analyses of HC symptoms, however, are lacking. In the present study, 27 patients with HC were exposed to personally relevant health-related stimuli under one of two conditions: (a) subsequently performing safety-seeking behaviors (e.g., checking) (n=14) or (b) subsequently being instructed not to perform such behaviors (n=13). In both groups, subjective anxiety and urges to perform safety behaviors were monitored for 1h. Results indicated that exposure to the personally relevant health trigger provoked anxiety and urges to perform safety behaviors. For patients who performed such behaviors, these feelings were reduced. For patients who did not, a more gradual reduction of anxiety and urges was observed. Findings are discussed in terms of the conceptualization and treatment of HC behavior, and are relevant to HC's possible relationship to panic and obsessive-compulsive disorder.     

Cognitive control of obsessional thoughts

A defining characteristic of obsessive-compulsive disorder (OCD) is unsuccessful suppression of unwanted thoughts. Recent evidence of individual differences in ability to control intrusive thoughts may inform our understanding of failures of cognitive control associated with OCD symptomatology. The current study investigated characteristics of cognitive style that are potentially associated with OCD symptoms and may influence response to unwanted thoughts, including perceived ability to control thoughts and tendency to ruminate. Undergraduate students (N = 166) completed self-report measures of OCD symptoms, perceived thought control, and ruminative thinking. They were then presented with a distressing target thought and completed a standard thought suppression paradigm. Correlational results indicated that, controlling for anxiety and depression, OCD symptoms were positively associated with rumination and inversely associated with perceived thought control ability. In addition, OCD symptoms were associated with higher levels of distress and greater spontaneous efforts to suppress the target thought during a baseline period, while perceived thought control ability predicted frequency of target thoughts during suppression. Finally, results of the experimental manipulation confirmed that participants instructed to suppress experienced more intrusions during the recovery period. Clinical implications and future directions are discussed.     

Health anxiety, hypochondriasis, and the anxiety disorders

Although clinical observations suggest that health-related anxiety is present, to some extent, in a number of anxiety disorders, this relationship has not been examined empirically. The present study therefore utilized the Short Health Anxiety Inventory (SHAI) to elucidate the structure of such symptoms among patients with anxiety disorders and to empirically investigate the presence of health anxiety in various anxiety disorders. Confirmatory factor analysis yielded equivalent support for either a 2-factor or 3-factor model of the SHAI's latent structure. The measure demonstrated good reliability, convergent validity, and discriminant validity. Comparison of SHAI scores across groups of patients with various anxiety disorders revealed elevated levels of health anxiety among patients with hypochondriasis and panic disorder relative to those with other anxiety disorders. Receiver operating characteristic analyses supported the utility of the SHAI as a diagnostic tool for screening patients with hypochondriasis utilizing empirically derived cut scores. Findings are discussed in terms of cognitive-behavioral models of anxiety disorders.     

Parenting Behaviors and Childhood Anxiety: A Psychometric Investigation of the EMBU-C

Parent rearing behaviors, including both behavioral modeling and parent–child interactions, are associated with anxiety in children. Patterns of overprotection or rejecting behavior from parents may lead children to develop behavioral avoidance, lower self-confidence, and higher symptoms of anxiety. Additional research is needed to further elucidate the role that parenting behavior plays in the development of childhood anxiety. Unfortunately, few measures of parenting behavior exist. The EMBU-C is a 40-item child-report measure of these behaviors, but empirical data supporting the psychometric properties of the EMBU-C are limited. The current investigation examined the psychometric properties of the EMBU-C in the context of childhood anxiety. Participants were 213 children with an anxiety disorder and 150 recruited from the community (all aged 8–13 years). Overall, the EMBU-C demonstrated promising psychometrics. In terms of convergent validity, parent rearing behaviors described on the EMBU-C were significantly related to children’s anxiety symptoms, anxiety-related disability, parenting stress, family functioning and children’s externalizing behaviors. Further, the overprotection and anxious-rearing subscales discriminated between clinical and community participants. Finally, parental overprotection significantly predicted increases in child anxiety and anxiety-related disability 1 year later. Thus, the EMBU-C appears to have value as a clinical tool for assessing parental factors that may contribute to anxiety in children. Recommendations for further item development and measure improvement are offered.     

The role of anxiety and perspective-taking strategy on affective empathic responses

Empathy is an important pro-social behaviour critical to a positive client–therapist relationship. Therapist anxiety has been linked to reduced ability to empathise and lower client satisfaction with therapy. However, the nature of the relationship between anxiety and empathy is currently unclear. The current study investigated the effect of experimentally-induced anxiety on empathic responses elicited during three different perspective-taking tasks. Perspective-taking was manipulated within-subjects with all participants (N = 52) completing imagine-self, imagine-other and objective conditions. A threat of shock manipulation was used to vary anxiety between-subjects. Participants in the threat of shock condition reported higher levels of anxiety during the experiment and lower levels of empathy-related distress for the targets than participants in the control condition. Perspective-taking was associated with higher levels of empathy-related distress and concern compared to the objective condition. The present results suggest that perspective-taking can to a large extent mitigate the influence of heightened anxiety on an individual’s ability to empathise.