Rumination, experiential avoidance, and dysfunctional thinking in eating disorders

The majority of research in eating disorders (ED) has investigated the content of disorder-specific thoughts, while few studies have addressed underlying cognitive-affective processes. A better understanding of processes underpinning ED may have important implications for treatment development. Two studies were conducted that investigated levels of rumination, beliefs about rumination, experiential avoidance, and aspects of schematic thinking in individuals with eating pathology. The latter was assessed with a newly designed ED-Sentence Completion Task (ED-SCT). Study 1 (N = 177) examined relations between ED psychopathology and these variables in a student population. Extending this, Study 2 (N = 26) assessed differences between patients with anorexia nervosa and healthy control participants. The results showed that ED psychopathology was related to disorder-specific cognitions, experiential avoidance as well as ruminative brooding but not reflection. A follow-up of anorexia nervosa patients indicated that changes in ED psychopathology were associated with changes in dysfunctional attitudes and maladaptive cognitive-affective processes. These findings highlight cognitive processes that may play an important role in the maintenance of eating pathology.     

Evaluating the cognitive avoidance model of generalised anxiety disorder: Impact of worry on threat appraisal, perceived control and anxious arousal

Generalised anxiety disorder (GAD) is characterised by persistent and uncontrollable worry. According to the cognitive avoidance theory of GAD, worry may function as an affective dampening strategy motivated by intolerance of negative emotional states. By facilitating avoidance of more distressing cognitions and associated affect, worry is said to preclude modification of the fear representation in memory, maintaining threat associations and perpetuating further anxiety and worry. The present study evaluated these assumptions in a treatment-seeking GAD sample. Sixty-one participants were randomly allocated to conditions in which they were instructed to worry, imaginally process or relax in response to an anxiety trigger. Results supported the detrimental impact of worry, showing maintained threat expectancies and decreased control perceptions compared to other modes of processing. However, skin conductance level increased as a function of worry and there was no suggestion that worry suppressed affective responding. These findings highlight the need for clarification of the mechanisms involved in the maintenance of threat associations and worry in GAD.     

Cognitive variables related to worry among adolescents: avoidance strategies and faulty beliefs about worry

Studies aiming to better understand worry have neglected children and adolescents. This constitutes an important limitation considering that excessive worry is frequent among adolescents and that patients suffering from excessive worries associate the beginning of their disorder with adolescence. This study evaluates the cognitive variables associated with worry in a sample of 777 adolescents. It attempts to determine whether cognitive avoidance and false beliefs about the usefulness of worries are present and associated with worries in adolescence. The results showed that participants with a high level of worry used more avoidance strategies and held more beliefs about worry. The results also revealed that avoidance of stimuli that trigger unpleasant thoughts and thought substitution were the major avoidance strategies related to worry among adolescents. The belief that worry helps to avoid future negative events was also related to worry. These findings may suggest that adolescents' worries are maintained by processes similar to those observed among adults.     

The effects of worry and rumination on affect states and cognitive activity

The effects of worry and rumination on affective states and mentation type were examined in an unselected undergraduate sample in Study 1 and in a sample of individuals with high trait worry and rumination, high rumination, and low worry/rumination in Study 2. Participants engaged in worry and rumination inductions, counterbalanced in order across participants to assess main and interactive effects of these types of negative thinking. During mentation periods, the thought vs. imaginal nature and the temporal orientation of mentations were assessed 5 times. Following mentation periods, negative and positive affect, relaxation, anxiety, and depression were assessed. Both worry and rumination produced increases in negative affect and decreases in positive affect. Worry tended to generate greater anxiety, and rumination tended to generate greater depression. Interactive effects were also found indicating that worry may lessen the anxiety experienced during subsequent rumination. Moreover, worry lessened the depressing effects of rumination. Worry was associated with significantly greater thought than imagery, compared to rumination. Rumination involved a progression from mentation about the past to mentation about the future over time. Implications for understanding the generation of negative affect and comorbid anxiety and depression are discussed.     

A cognitive model of pathological worry

We present an evidence-based model of pathological worry in which worry arises from an interaction between involuntary (bottom-up) processes, such as habitual biases in attention and interpretation favouring threat content, and voluntary (top-down) processes, such as attentional control. At a pre-conscious level, these processes influence the competition between mental representations when some correspond to the intended focus of attention and others to threat distracters. Processing biases influence the probability of threat representations initially intruding into awareness as negative thoughts. Worry in predominantly verbal form then develops, influenced by conscious processes such as attempts to resolve the perceived threat and the redirection of attentional control resources to worry content, as well as the continuing influence of habitual processing biases. After describing this model, we present evidence for each component process and for their causal role in pathological worry, together with implications for new directions in the treatment of pathological worry.     

Vagal influence during worry and cognitive challenge

Abstract

The primary foci of the study were exploration of the linkage between cognitive and autonomic inflexibility of worry and generalized anxiety disorder (GAD) and examination of the effects of an analog cognitive restructuring task on this relationship. Cardiac responses of GAD and non-GAD participants were measured to examine the sympathetic and parasympathetic effects of worry and cognitive challenge. Diagnostic groups of undergraduate students were determined via administration of a structured interview, yielding a GAD group (n=16) and a control group (n=19) of individuals without GAD, depression, or panic disorder diagnoses. Cardiac autonomic responses were acquired via electrocardiogram during rest, worry, and cognitive challenge conditions by an experimenter blind to diagnosis. Metrics were compared between the two groups and across the three conditions. Individuals diagnosed with GAD did not differ significantly from controls on autonomic indices. Worry was associated with significantly decreased parasympathetic influence and increased sympathetic activity. Cognitive challenge did not result in significant increased cardiac responsivity. The results indicate that worry behavior is associated with decreased vagal activity, suggest a linkage between autonomic and cognitive inflexibility, and provide further suggestions for improving protocols to assess the autonomic effects of cognitive therapy techniques.     

Distress intolerance and worry: the mediating role of cognitive variables

Background and Objectives: Distress intolerance (DI) has been identified as a potential risk factor for a variety of maladaptive avoidance behaviors, including worry. However, mechanisms linking DI to specific behaviors remain poorly understood. One hypothesis is that DI is a general vulnerability that confers risk of particular avoidance behaviors via more specific, lower-order vulnerabilities. The current study examined associations between DI and worry-related cognitions. Design: A multiple mediator model tested the hypothesis that worry-related variables (intolerance of uncertainty [IU], cognitive avoidance, beliefs about worry, and negative problem orientation) mediated the association between DI and worry. Methods: An undergraduate student (n = 281) and a clinical (n = 123) sample completed self-report measures. Results: Across samples, worry was associated with higher levels of DI, IU, cognitive avoidance, beliefs about worry, and negative problem orientation. Mediation results differed somewhat between the two samples. In the undergraduate sample, IU, negative beliefs about worry, and positive beliefs about worry mediated the association between DI and worry. In the clinical sample, negative problem orientation and negative beliefs about worry mediated the association between DI and worry. Conclusions: Results provide initial evidence that DI may be associated with worry via unique risk factors.     

Assessing posttraumatic cognitive processes: the Event Related Rumination Inventory

Cognitive processes in the aftermath of experiencing a major life stressor play an important role in the impact of the event on the person. Intrusive thoughts about the event are likely to be associated with continued distress, while deliberate rumination, aimed at understanding and problem-solving, should be predictive of posttraumatic growth (PTG). The Event Related Rumination Inventory (ERRI), designed to measure these two styles of rumination, is described and validation information is provided. Using a college student sample screened for having experienced highly stressful life events, data were obtained (N=323) to conduct an exploratory factor analysis that supported the two factors of the ERRI. Separate confirmatory factor analyses (CFA) on two additional samples (Ns=186 and 400) supported a two-factor model. The two ERRI factors were validated by comparison with related variables and by assessing their contributions to predicting distress and PTG in two samples (Ns=198 and 202) that had been combined to conduct the second CFA. Data indicate the ERRI has solid psychometric properties, captures variance not measured by stable differences in cognitive styles, and the separate factors are related to posttraumatic distress and growth as predicted by existing models of PTG.     

Deleterious effects of alcohol intoxication: diminished cognitive control and its behavioral consequences

The authors tested the hypothesis that impaired behavioral performance during intoxication results partly from alcohol's deleterious effects on cognitive control. The impact of alcohol on perseverative behavior was examined with an n-back working memory task that included manipulations of task complexity and prepotency of inclinations to respond or withhold responding. Thirty-two social drinkers (16 men) participated in either an alcohol (.075g/100ml) or a no-alcohol condition. Alcohol increased perseveration of prepotent, task-inappropriate response patterns only under cognitively demanding (heavy memory load) conditions. This effect was evident for both commission errors (response persistence despite contingencies altered to require restraint) and omission errors (failure to respond when contingencies were revised to encourage action). Findings suggested that alcohol-induced perseveration arises from impairments in cognitive control.     

Social problem solving training: A follow-up study of cognitive and behavioral effects

The long term effects of Spivack and Shures' social problem-solving training were assessed and compared to an attention-placebo control. Thirty-seven preschool age children were involved in this year's long intervention project and six month follow-up. All subjects received 46 sessions of intervention by specially trained assistants. Support was found for the cognitive effectiveness of social problem-solving training with aberrant children at post test in that they gained significantly in their ability to generate alternative solutions to interpersonal problems. This differential effect was not sustained at follow-up. Blind teacher ratings of behavioral adjustment and independent observers' ratings of behavior (using a naturalistic observation scale developed for this study) revealed no significant behavioral training effects at post test or at follow-up. Findings are discussed with the suggestion that behavior change in young children may not be mediated through a strictly cognitive intervention, and may more logically require an integration of behavioral and cognitve techniques.     

Understanding adolescent worry: the application of a cognitive model

The relationship between worry and 4 cognitive variables, intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance, was examined in an adolescent sample of 528 boys and girls aged 14–18. The participants completed questionnaires assessing worry, somatic anxiety symptoms, and the variables mentioned above. The results show that (a) intolerance of uncertainty, positive beliefs about worry, and negative problem orientation each account for a significant amount of variance in adolescent worry scores in the multiple regression, and (b) the discriminant function derived from the 4 variables is effective in classifying moderate and high worriers into their respective groups (72.8% correct classification). Furthermore, analyses demonstrate that intolerance of uncertainty has the strongest association with worry scores and is the most important variable in discriminating between moderate and high adolescent worriers. These results suggest that intolerance of uncertainty plays a key role in our understanding of adolescent worry.     

Chronic worry and the temporal dynamics of emotional processing

Worriers avoid upsetting thoughts yet also demonstrate vigilance for aversive emotional information. Potentially, these processes coexist but are separated in time. Individuals scoring high on a measure of chronic uncontrollable worry were compared to low scorers during valence categorization of emotional stimuli with interleaved Stroop color word trials to monitor extended effects of emotional processing. High worriers were especially fast and accurate in judging the valence of emotional words compared to low worriers. Worriers also had smaller pupil diameters following personally relevant negative emotional stimuli compared to low worriers. Correlations with self-report scales indicated associations between the worrier pupil response profile and symptoms of chronic worry and depression. The combined behavioral and physiological data support theories of emotional vigilance followed by avoidance in worriers.     

Social phobia: individual response patterns and the effects of behavioral and cognitive interventions

In the present study, the role of individual response patterns in the treatment of social phobic patients was investigated. Seventy-four patients were diagnosed as social phobics. On the basis of extreme scores on a behavioral test (the Simulated Social Interaction Test) and on a cognitive measure (the Rational Behavior Inventory), the response patterns of 39 patients were analyzed, and the patients themselves were classified as either 'behavioral reactors' or 'cognitive reactors'. Half of the patients with each response pattern received a behavioral focused treatment, i.e. social skills training (SST), while the other half received a cognitive oriented treatment, i.e. rational emotive therapy (RET). Patients received group therapy in eight weekly sessions. Within-group differences showed a considerable improvement in all treatment groups. Between-group differences failed to lend support to the hypothesis that treatment that fits a response pattern (i.e. SST for behavioral reactors and RET for cognitive reactors) will result in a greater improvement than one that does not.     

Approach, avoidance, and inhibition: Personality traits predict cognitive control abilities

The extent to which approach and avoidance personality trait sensitivities are associated with specific cognitive control abilities as well as with verbal and nonverbal domains remains unclear. In the current study, we investigated whether approach and avoidance trait sensitivities predict performance on verbal and nonverbal versions of the Stroop task, which taps the specific cognitive control ability of inhibiting task-irrelevant information. The findings from the current study indicate that whereas approach (specifically, Extraversion) sensitivity was predictive of verbal Stroop performance, avoidance (specifically, Behavioral Inhibition System) sensitivity was predictive of nonverbal Stroop performance. These results provide novel evidence suggestive of the integration of motivational personality traits and the ability to inhibit task-irrelevant information in a domain-specific fashion.     

Physiological and behavioral concomitants of mild stress: The effects of accuracy of temporal information

Sixty human subjects were exposed to a mild auditory stress after a fixed anticipatory period during which they performed a reaction time task. Suspense subjects were correctly informed of the time of onset of stress; Surprise subjects were told to expect the stress 10 min. later than it actually occurred. Subjects were provided with elapsed time information either automatically or on demand. Suspence subjects showed larger anticipatory electrodermal responses and smaller responses to stress than Surprise subjects but the two groups did not differ in their ratings of the unpleasantness of the stress. Female subjects showed greater anticipatory responses and consistently slower reaction times than males. The data are discussed in terms of explanations of the negative preception effect.     

The impact of personality on cognitive, behavioral, and affective political processes: the effects of need to evaluate

Need to evaluate (NE) is a personality trait that reflects a person's proclivity to create and hold attitudes; people high in NE are especially likely to form attitudes toward all sorts of objects. Using data from the 1998 National Election Survey Pilot and the 2000 National Election Survey, NE was shown to predict a variety of important attitude-relevant cognitive, behavioral, and affective political processes beyond simply holding attitudes: NE predicted how many evaluative beliefs about candidates a person held, the likelihood that a person would use party identification and issue stances to determine candidate preferences, the extent to which a person engaged in political activism, the likelihood that a person voted or intended to vote, the extent to which a person used the news media for gathering information, and the intensity of emotional reactions a person felt toward political candidates. Thus, NE appears to play a powerful role in shaping important political behavior, emotion, and cognition.     

Blirtatiousness: cognitive, behavioral, and physiological consequences of rapid responding.

The Brief Loquaciousness and Interpersonal Responsiveness Test (BLIRT) measures the extent to which people respond to others quickly and effusively. The BLIRT displays desirable psychometric properties and distinguishes people who should theoretically score high (e.g., car salespersons) from those who should score low (e.g., librarians). Scores on the scale predict (a) the amount and rapidity of people's verbal responses in an unstructured interaction, (b) how likable and competent people's classmates perceive them to be early in the semester, (c) how quickly people respond to an obnoxious cell-phone user and how physiologically aroused they become, and (d) how quickly and emphatically people respond to a series of personal insults as well as their degree of physiological arousal. Converging evidence indicates that blirtatiousness is unique in its ability to amplify people's qualities, making these qualities more readily observable to perceivers.